Multiple Sclerosis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate multiple sclerosis (MS):

Early symptoms

  • Optic neuritis (inflammation of the optic nerve; synonyms: Neuritis nervi optici; retrobulbar neuritis; usually unilateral/only 0.4% of patients develop disease in both eyes simultaneously; most common symptom of a relapse of MS; approximately 50% of patients with typical optic neuritis develop multiple sclerosis within 15 years. )Symptoms: Visual disturbances are usually preceded by pain in the eye region, lasting a few days to weeks and occurring accentuated by eye movements (= eye movement pain; 92% of patients), followed by visual deterioration: increase in often unilateral visual deterioration over days, with flashes of light (photopsia) often provoked by eye movements; trough within one to two weeks – then improvement in 95% of cases.Symptoms:
    • Visual impairment with bulbar movement pain (absent in about 8% of patients when the focus of inflammation is intracranial).
    • Monocular or binocular visual loss (vision loss).
    • Blurred vision to complete loss of visual acuity (vision loss).
    • Disturbed color perception (colors are perceived as dirty and pale).
  • Sensory disturbances (tuning fork test).
  • Leg weakness or gait unsteadiness – 9-fold higher rate of gait and movement disturbances in the two years prior to MS diagnosis.
  • Paresthesias (numbness) – altered sensitivity such as tingling or prickling – 5-fold higher rate of skin sensation disturbances in the year before MS diagnosis
  • Diplopia (double vision, double images).

Other notes

  • MS patients already claim medical help with striking frequency in the five years before diagnosis (increase in the number of visits to doctors and clinics, as well as medication prescriptions).
  • Not infrequently, the disease initially begins with an isolated symptom, for which the English term “clinically isolated syndrome” (CIS) has become common. Note: Approximately one-third of these patients do not develop multiple sclerosis even in the long term. Patients with CIS who develop MS have a stable, benign course over three decades in about 40%. Magnetic resonance imaging (MRI) has demonstrated two prognostically relevant factors: Number of infratentorial lesions (changes “below the tentorium”/transverse meningeal structure between the occipital lobe/occipital lobe of the cerebrum and the cerebellum) at CIS diagnosis and “deep white matter lesions” (DWM) one year after CIS diagnosis. If these two factors did not occur in the first year after CIS diagnosis, the probability of disabling multiple sclerosis at 30 years was 13%. In contrast, if DWM was present, it was 49%, and if DWM plus infratentorial lesions were present, it was 94%.

Symptoms

  • Ataxia (gait disturbances)
  • Bladder emptying disorders
  • Chronic fatigue states
  • Depression
  • Dysarthria (speech disorder) – chanting speech* (slow, choppy, and slurred speech).
  • Euphoria – exaggerated feeling of happiness, not corresponding to the objective state.
  • Memory disorders
  • Urinary urgency
  • Urinary incontinence – inability to hold urine.
  • Hypesthesias – decreased sensation of pain.
  • Hyperreflexia – increased reflexes.
  • Cognitive deficits or cognition disorders.
  • Concentration disorders
  • Nocturia – urination at night
  • Nystagmus* (eye tremor)
  • Constipation (constipation)
  • Paresthesias – altered sensitivity such as tingling or prickling.
  • Periorbital pain – pain around the eye socket.
  • Problem solving difficulties
  • Pain – all over the body or in alternate parts of the body.
  • Painful cramps
  • Sexual dysfunction – loss of libido, impotence or genital numbness.
  • Spasticity – increase in muscle tension
  • Urge to defecate
  • Fecal incontinence
  • Tremor (shaking; in this case: Intention tremor* /trembling of the limbs during a purposeful movement).
  • Trigeminal neuralgia – pain on one side of the face due to inflammation of the facial nerve.
  • Uveitis – inflammation of the middle skin of the eye.
  • Vertigo (dizziness)

* Charcot triad I

Symptoms at first manifestation under 10 years

  • Ataxia and brainstem symptoms (more common than later disease).
  • Brainstem symptoms: Cranial nerve disorders (e.g., eye movement disorders with diplopia (double vision), gaze direction nystagmus; speech disorders, dysphagia (difficulty swallowing); dyspnea (shortness of breath)).
  • Lesions in the cerebellum: incoordination, intention tremor, vertigo (vertigo), gait and stance ataxia, gait unsteadiness.
  • Sensorium: sensory disturbances (numbness, tingling paresthesias, dysesthesias).
  • Motor deficits: paresis; tone regulation disorders (common).
  • Neuropsychological symptoms: decreased ability to think and concentrate, learning difficulties, decreased social interaction; emotional disturbances, anxiety disorders, etc. may occur in the course of time
  • Nonspecific symptoms such as fatigue, cephalgia (headache), tension and dizziness.

Warning signs (red flags)

* The prevalence (disease frequency) of headache in MS is approximately 50-70%. In addition to the above causes, headache may also occur as side effects of MS therapy.