MULTIPLE SCLEROSIS SYMPTOMS

The symptoms of multiple sclerosis may occur in one of three patterns:

•  The most common pattern is the "relapsing-remitting" pattern, in which there are clearly defined symptomatic attacks lasting 24 hours or more, followed by complete or almost complete improvement. The period between attacks may be a year or more at the beginning of the disease, but may shrink to several months later on. This pattern is especially common in younger people who develop MS.

•  In the "primary progressive" pattern, the disease progresses without remission or with occasional plateaus or slight improvements. This pattern is more common in older people.

•  In the "secondary progressive" pattern, the person with MS begins with relapses and remissions, followed by more steady progression of symptoms.

Between 10-20% of people have a benign type of MS, meaning their symptoms progress very little over the course of their lives.

Because plaques may form in any part of the central nervous system, the symptoms of MS vary widely from person-to-person and from stage-to-stage of the disease. Initial symptoms often include:

•  muscle weakness, causing difficulty walking

•  loss of coordination or balance

•  numbness, "pins and needles," or other abnormal sensations

•  visual disturbances, including blurred or double vision

Later symptoms may include:

•  fatigue

•  muscle spasticity and stiffness

•  tremors

•  paralysis

•  pain

•  vertigo

•  speech or swallowing difficulty

•  loss of bowel and bladder control

•  incontinence, constipation

•  sexual dysfunction

•  cognitive changes

Weakness in one or both legs is common, and may be the first symptom noticed by a person with MS. Muscle spasticity, or excessive tightness, is also common and may be more disabling than weakness.

Double vision or eye tremor (nystagmus) may result from involvement of the nerve pathways controlling movement of the eye muscles. Visual disturbances result from involvement of the optic nerves (optic neutritis) and may include development of blind spots in one or both eyes, changes in color vision, or blindness. Optic neuritis usually involves only one eye at a time and is often associated with movement of the effected eye.

More than half of all people affected by MS have pain during the course of their disease, and many experience chronic pain, including pain from spasticity. Acute pain occurs in about 10% of cases. This pain may be a sharp, stabbing pain especially in the face, neck, or down the back. Facial numbness and weakness are also common.

Cognitive changes, including memory disturbances, depression, and personality changes, are found in people affected by MS, though it is not entirely clear whether these changes are due primarily to the disease or to the psychological reaction to it. Depression may be severe enough to require treatment in up to 25% of those with MS. A smaller number of people experience disease-related euphoria, or abnormally elevated mood, usually after a long disease duration and in combination with other psychological changes.

Symptoms of MS may be worsened by heat or increased body temperature, including fever, intense physical activity, or exposure to sun, hot baths, or showers.