Symptoms

Symptoms of multiple sclerosis appear in a variety of ways. Most patients first have a single attack of symptoms called a clinical isolated syndrome, which typically occurs between the ages of 20 - 40 years. Initial symptoms may be mild enough that patients do not always quickly seek medical care. Once a second attack occurs, the patient is considered to have relapsing-remitting multiple sclerosis. Much less commonly, the disease is progressive from the start, with the patient having more or less continuous symptoms.

Early Symptoms

Symptoms more likely to occur earlier in the disease include:

Optic neuritis and other eye problems.

• Optic neuritis, inflammation of the nerves in the eye, affects over 50% of patients and is the first symptom in about 16% of patients. Symptoms include unclear or doubled vision, usually in one eye. Some people see a shimmering effect. Patients may also have pain or involuntary jerking or movement of the eye (called nystagmus). In 20% of people with this condition, MS develops within 2 years after the onset of these symptoms.
• Other symptoms may include difficulty tracking with both eyes and a sensation that the environment is moving.

Fatigue. Fatigue is typically worse in the afternoon and may be accompanied by an increase in body temperature. At the onset, this occurs in about 20% of patients, but as the disease progresses, this is a significant symptom in nearly all patients.

Changes in sensations in the arms and legs.

• Patients can feel heaviness, weakness, or clumsiness in the limbs.
• Tingling or loss of sensations can also occur, usually in the legs. Symptoms often begin at the end of the legs or arms and move up towards the beginning of the limb. The patient may also have painful sensations around the abdomen.
• Lhermitte's sign is often an early sign of multiple sclerosis. This electrical sensation, produced by bending the neck forward, runs down the back and into the legs.

Muscle weakness in the legs and poor coordination. Weakness may often occur during heat exposure and after exercise. Patients may also have problems with balance and a tremor.

Spasticity. Spasticity is the inability to control muscle tone, leading to spasms and stiffness. It is very common in MS. Symptoms include sensations of burning, itching, aching, and quivering. They usually occur in the arms and legs and last from seconds to minutes.

Disturbances in the bladder. Some patients have problems urinating at will, a condition called urinary retention. It often takes the form of urge incontinence (also called hyperactive or irritable bladder). People with urge incontinence need to urinate frequently or are unable to reach the bathroom before leakage occurs.

Bowel dysfunction. Patients often experience constipation and episodes of stool incontinence.

All symptoms continue over time.