MS: signs and symptoms

How can multiple sclerosis affect me?

Multiple sclerosis may cause several types of symptoms as it can affect many parts of the central nervous system. Symptoms depend upon the location of lesions in the CNS and the type of MS. If you have relapsing-remitting MS or clinically isolated syndrome, symptoms come on acutely or sub acutely over a period of days with maximum deficits within one month and then spontaneous progressive improvement. Typical MS symptoms are: unilateral visual loss (optic neuritis), double vision, facial numbness or pain, loss of balance and/or incoordination, numbness and tingling, weakness, and urinary incontinence or erectile dysfunction. An unusual electric like sensation that occurs when bending the neck, radiates down the back and sometimes into one or more limbs is called Lhermitte’s symptom. More than one symptom can occur at the same time. (Brownlee et al 2017)

Slowly progressive neurological symptoms that worsen over months to years are typical for primary progressive MS. Generally, this begins with weakness in both legs with one worse than the other. Less often patients have weakness on one side of the body or incoordination of arms or legs. Rarely there is progressive visual loss or cognitive impairment.

Fatigue is a common symptom of MS. According to the National Multiple Sclerosis Society, fatigue affects about 80% of patients with MS (htt6). The cause of fatigue due to MS is unknown. However, there are other medical conditions and vitamin deficiencies that cause fatigue and may coexist with MS. These treatable medical conditions and vitamin deficiencies need to be looked for before attributing your fatigue to MS.

Can MS affect memory and thinking?

Estimates of cognitive dysfunction in MS range from 43 to 70% and can occur early in the course of MS or later (Chiaravalloti and Deluca 2008). Rao, in 1991, tested 100 community patients (rather than patients from a referral center where one would expect more severe MS patients to be followed and thus the frequency of cognitive impairment to be higher) and found almost half (43 patients) were impaired on four or more cognitive tests (Rao, et al. 1991). Amato et al. followed 45 patients with MS over 10 years. Initially 74% were cognitively normal but this decreased to 51% at 4 years and 44% at 10 years (Amato MP 2001)

When cognitive problems occur, information processing speed, visual learning and long-term memory are most commonly involved, though attention and executive function can also be affected (Chia 2008). A decrease in information processing speed causes difficulty performing tasks quickly, performing multiple tasks at the same time and shifting attention. Verbal and visual memory problems present as forgetfulness. A problem with attention causes a tendency to be easily distracted. Problems with executive function leads to difficulties in solving thought problems or rigidity in solving problems.

Should I have my thinking abilities checked?

You should have your thinking abilities checked if you feel you are having a problem with your thinking; when others around you think you are having a problem with your memory or thinking; if you are having problems at work; or, if you are doing the type of work which relies on your memory and thinking quickly.

Will MS affect my family?

Multiple sclerosis can affect your family in one of two ways. Generally, when someone asks this question, they are asking if MS is an inheritable condition and what is the likelihood that another family member will get the disease. MS is not an infectious disease, so that family members cannot catch MS from you. There is a genetic component to the risk for MS so that your brothers or sisters or children do have a slight increased risk of getting MS. In the general population, a person has a 0.1% to 0.2% chance of developing MS. The highest family risk for MS is in identical twins who have up to 31% risk. Non identical twins have a 2-5% risk. Brothers or sisters have a 2% to 4% risk and children of people with MS have a risk of developing MS at 3% to 5%. (Compston A, 2008). A child of two parents with MS has a 6% risk of developing MS (Markowitz 2014)

MS can have a significant impact on your immediate family in other ways as well. MS frequently occurs in young people as they are beginning their careers or family. Parents, husbands, wives, and children don’t expect you to be sick and often have difficulty in acknowledging your illness and the problems it may cause you. People with MS often look well, and people around you may not understand that although “you look so good” that you may not feel so well.

What can I expect to occur in the future?

Understanding your prognosis (which means what can happen to you in the future) is important so that you and your family have a general idea about what may happen to you. This will help you and your family plan for the future and give you a background against which to discuss possible treatments with your neurologist.

Given our current knowledge about MS, it is impossible to predict for sure what will happen to you. This is because there are inherent variations between people with MS and between groups of people with MS (Thompson 1998).  This variation means that what happens to you may be different from what happens to others with MS. Different groups of people with MS also can show different characteristics of the disease and have different outcomes than other groups which becomes important when looking at studies of MS patients to see what happens to them.

Another reason it is not possible to predict for sure what will happen to you is that our knowledge of what happens to people with MS comes from studies which have followed groups of people with MS over time. From these studies, your neurologist knows what will happen in general to people with MS but not what will happen to a specific individual. Your neurologist thus can only speak in terms of what is likely to happen or the risk of certain things happening to you, not what will definitely occur to you.

In view of this uncertainty, one way of presenting information is in terms of a worst-case and best-case scenario. For example, we know that on average a person with MS will require a cane to walk by 20 years. A worst-case scenario for you would be to require a cane sooner than 20 years while a best-case scenario would be to go for more than 20 years without needing a cane. Using another example, we know that about 50% of people with relapsing-remitting MS will convert to secondary progressive MS within 10 years of onset.  The best-case scenario would be that, if you are diagnosed with relapsing-remitting MS, you don’t convert to secondary progressive MS by ten years. The worst-case scenario would be that you convert earlier than 10 years.

References

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