MS Symptoms and Diagnosis

What are the symptoms of multiple sclerosis?

Because of the way multiple sclerosis (MS) disrupts how the brain and spinal cord communicate with the rest of the body, symptoms can affect people in different ways and strike different parts of the body.

Symptoms vary based on which location within the central nervous system is affected and the degree of damage. They often appear between age 20 and 50 and can come and go in relapses, or they can get worse over time.

Some people only have mild symptoms and can go a long time before they have any new ones. The stretch of time without new symptoms is called remission.

The severity of symptoms fluctuates and can look different for different people. 

Some of the most common symptoms are directly caused by the way MS affects the nervous system. They include: 

• Numbness or tingling: You may notice these feelings, called paresthesia, in your face, arms, legs or fingers, specifically affecting one side of your body.
• Shock sensations: When you move your neck it may feel like an electric shock. This is called Lhermitte’s sign.
• Muscle weakness or spasms: Weakness affecting your arm, leg or one side of your body. After a while, you might notice spasticity or spasms affecting your muscles. 
• Dizziness and balance issues: Incoordination affecting your hand or leg, or loss of dexterity can happen. These symptoms can also make walking hard. 
• Vision problems: You may have blurred or double vision or pain when you move your eyes. You may notice differences in the way you see red and green colors. Vision problems can come from optic neuritis (swelling in the optic nerve) and usually affect one eye at a time.
• Speech and hearing problems: It may become hard for you to talk or hear properly. You may slur your speech.
• Bladder, bowel or sexual changes: You could have trouble controlling your bladder or bowels and have changes in your sexual function.

You may also experience other MS-related symptoms that are not directly related to it’s affects on the nervous system. These may include:

• Fatigue: Feeling very tired is one of the most common and disabling symptoms. You might feel exhausted after physical activity and better after you rest or you might feel fatigued all the time.
• Thinking changes: MS may make it hard for you to concentrate or remember things. You may have trouble paying attention or using good judgment.
• Mood changes: You may face depression or have emotional shifts.
• Secondary complications: MS can lead to other complications, like getting urinary tract infections from bladder problems or pneumonia from swallowing problems.

When should you talk to a health care provider?

Contact a health care provider if you notice numbness, weakness, vision changes or incoordination lasting more than 24 hours, especially if these symptoms don’t improve with rest or are accompanied by other symptoms. Early diagnosis matters. It can lead to more timely treatment and improve your quality of life.

How is MS diagnosed?

Because MS affects everyone differently and can mimic other conditions, reaching a diagnosis may be challenging and take time. You may want to see a neurologist who specializes in MS for testing and diagnosis.

There’s no single test for MS, so health care providers use a combination of tests to rule out other causes and confirm MS: 

• Health history: Questions about your vision, balance, senses, movement, coordination, language and mental and emotional functions can help with a diagnosis.
• Neurological exam: This test checks for changes or issues with your coordination, vision, reflexes and strength.
• MRI scans: These imaging tests look for lesions or damage in the brain and spinal cord. You may need a contrast dye to see if you have active MS-related changes.
• Lumbar puncture (spinal tap): This test checks cerebrospinal fluid for signs of inflammation. It can also rule out some other conditions that could be causing your symptoms.
• Optical coherence tomography: This test creates images of the eye with light waves. It can check for damage to the retinal nerve and changes in the thickness of the retina.
• Blood tests: Blood tests can help rule out other causes of symptoms.
• Evoked potentials: These tests measure how quickly your brain responds to sensory input like sight, sound or touch.

Types of multiple sclerosis

There are different forms of MS, based on how the symptoms are getting worse and how often relapses happen.

Relapsing-remitting MS (RRMS)

RRMS is the most common type of MS. It causes repeat attacks with times in between when symptoms aren’t as severe. You may have new symptoms or a relapse that lasts days or weeks. After that, your symptoms improve or clear up in remissions that could last for months or years.

You may be diagnosed with this type of MS if you have had two attacks at least a month apart and you have at least two areas with myelin damage. Diagnosis is typically based on symptoms and MRI results showing lesions in specific MS locations. This is done by a neurologist or an MS specialist. 

Secondary progressive MS (SPMS)

RRMS can change to SPMS over time. In SPMS, symptoms start to steadily get worse, with or without times of remission. Symptoms usually affect movement and walking and may get worse more slowly or more quickly in different people with this type of MS.

SPMS affects 20% to 40% of people with RRMS and usually starts 10 to 20 years after MS diagnosis. Even though it’s treatable, it can be frustrating and harder to treat compared to RRMS.

Primary progressive MS (PPMS)

PPMS causes symptoms that get worse over time but don’t come in attacks. There could be times when symptoms are stable or improve a little bit, but generally they get worse. The speed they take to get worse can vary. 

About 10% of people with MS have this type and it affects men and women evenly. It’s harder to treat than other types of MS.

Rare forms of MS

These types of MS are not found very often:

• Tumefactive multiple sclerosis: Lesions look like brain tumors. A provider may need to take a brain tissue sample to see if it is MS or a brain tumor.
• Balo’s concentric sclerosis: Lesions appear in the shape of a target.
• Marburg variant multiple sclerosis: This aggressive type of MS gets worse quickly.

You could also be diagnosed with:

• Clinically isolated syndrome: This refers to the first time you have a symptom inidicating the first attack of MS. Testing may show that you have some changes indicating MS but you do not meet the full criteria yet.
• Radiologically isolated syndrome: This refers to signs on an MRI that look like MS when you don’t have noticeable symptoms of MS.

Learn more about the treatment options for MS and what you can do to manage your symptoms and slow down the damage from the condition.

If you’re worried about your symptoms, consult with a Banner Health neurologist for advice and guidance.