Multiple Sclerosis Symptoms: Early Signs, Relapses and When to Get Checked

01Basics

What is multiple sclerosis?

In MS the immune system attacks myelin, the protective sheath that covers nerve fibers in the brain and spinal cord. Mayo Clinic compares myelin to the insulation on electrical wires: when it is damaged, messages traveling along the nerve may be slowed or blocked. Over time the disease can cause permanent damage to the nerve fibers.

Which symptoms appear depends on where the damage is and how severe it is, so MS can affect vision, sensation, coordination, movement, and bladder or bowel control. The NHS stresses that everyone with MS is affected differently. MS cannot currently be cured, but treatment can often help manage it.

02Vision

Vision problems

Problems with the eyes are among the most common symptoms in the NHS list, such as blurred vision or eye pain. Mayo Clinic describes:

• partial or complete loss of vision, usually in one eye at a time, often with pain when moving the eye
• double vision
• blurry vision

Sudden loss or blurring of vision is one of the symptoms for which the NHS advises calling the emergency number, because it can also be a sign of a stroke.

03Sensation and strength

Numbness, tingling, weakness and stiffness

Numbness or a tingling feeling in different parts of the body is one of the most frequent MS symptoms. Mayo Clinic also lists weakness and electric-shock sensations with certain neck movements, especially bending the neck forward, known as Lhermitte sign. This is something to tell your doctor about, not something to test for at home.

The NHS mentions muscle cramps, spasms and stiffness, and Mayo Clinic lists muscle stiffness or spasms and, in more severe cases, severe weakness or paralysis, typically in the arms or legs, among the possible complications.

04Balance

Balance, coordination and walking

People with MS may feel off balance, dizzy or clumsy. Mayo Clinic lists lack of coordination, trouble walking, dizziness and vertigo, a false sense that you or your surroundings are moving. Slurred speech can also occur.

Over the years, problems with mobility can increase. According to the NHS, some people need walking aids, home adaptations or changes to their working hours, while others have only a small impact on daily life.

05Fatigue and thinking

Fatigue, memory and mood

Feeling extremely tired (fatigue) is one of the most common symptoms. Problems with memory, concentration, thinking and understanding information are also listed by both sources.

Mood can change too. Mayo Clinic mentions depression, anxiety and mood swings, and the NHS includes cognitive behavioral therapy for anxiety, depression and fatigue among the support people may be offered.

06Other symptoms

Bladder, bowel and sexual symptoms

MS can affect the bladder: needing to pee more often or not being able to control when you pee. Bowel problems and sexual problems, such as vaginal dryness or erection problems, are also possible. The NHS notes that advice, exercises and medicines can help with these symptoms, so it is worth mentioning them even if they feel embarrassing.

Mayo Clinic adds that seizures can happen but are very rare.

07Course

Relapses, remissions and types of MS

Symptoms may come (flare-ups or relapses) and go (remissions), and may get worse over time. Mayo Clinic explains that in relapsing-remitting MS, the most common type, new symptoms develop over days or weeks and usually improve partly or completely, followed by quiet periods that can last months or years. Some people later develop secondary progressive MS, with symptoms that slowly get worse. In primary progressive MS, which is less common, symptoms worsen gradually from the start without relapses.

Not every worsening is a relapse. Small increases in body temperature can temporarily worsen MS symptoms; Mayo Clinic calls these pseudorelapses. A symptom diary with dates, symptoms and possible triggers such as heat or infection can help the specialist, but it does not diagnose MS.

08Diagnosis

How MS is diagnosed and when to get checked

The NHS advises seeing a GP if you think you have MS symptoms, and Mayo Clinic advises an appointment for any symptoms that worry you. If MS is suspected, a neurologist (brain and nerve specialist) will ask about your symptoms. There is no single test for MS. Tests may include:

• checks of movement, coordination, vision, balance and reflexes
• blood tests
• an MRI scan to look for damage to nerves in the brain or spinal cord
• a lumbar puncture to take a small sample of spinal fluid
• tests with small sensors on the skin that measure how quickly messages from the eyes or ears travel to the brain

Mayo Clinic also describes clinically isolated syndrome, a first episode affecting myelin that may later be diagnosed as MS or as another condition. Treatment, when MS is confirmed, includes medicines that reduce relapses, steroid medicine for attacks and support from a team that may include an MS nurse, physiotherapists and occupational therapists. If you have symptoms that worry you, talk to your doctor: this guide cannot tell you whether they are caused by MS.

09Sources

Where the sources differ

Age of onset. The NHS says you may be more likely to get MS if you are aged 20 to 50; Mayo Clinic says onset most commonly happens between 20 and 40, while noting that MS can happen at any age.

How symptoms are grouped. The NHS puts fatigue and vision problems at the top of its list of common symptoms; Mayo Clinic opens its list with numbness or tingling and includes Lhermitte sign, slurred speech and vertigo, which the NHS overview does not name.

Risk factors. Both mention family history, being a woman, smoking and the Epstein-Barr virus. Mayo Clinic adds climate, low vitamin D, obesity and other autoimmune diseases. These are factors linked with a higher risk, not causes: neither source says why MS develops in one person and not another.

10Summary

In summary

MS symptoms vary widely: fatigue, vision problems, numbness or tingling, weakness, poor balance, muscle stiffness, bladder and bowel problems, and memory or mood changes are the most common. They often come in relapses that improve, and heat can briefly make them worse.

These symptoms have many other causes, and there is no single test: a neurologist puts together the examination, MRI and other tests. Sudden weakness or numbness in one arm, sudden vision loss or sudden loss of balance need emergency care, because they can be a stroke.