Multiple Sclerosis: Early Symptoms and How MS Is Diagnosed

Multiple sclerosis (MS) is a chronic condition of the central nervous system, which includes the brain, spinal cord and optic nerves. It is most often diagnosed between the ages of 20 and 50 and is more common in women. The outlook for people with MS has changed dramatically over the past few decades. Today, early diagnosis and treatment can reduce relapses and help protect long-term function, which makes recognizing the first symptoms especially important.

What Happens in MS?

Nerve fibers in the brain and spinal cord are wrapped in a protective coating called myelin, which helps electrical signals travel quickly. In MS, the immune system mistakenly attacks myelin and, over time, the nerve fibers underneath. The areas of damage, called lesions or plaques, disrupt communication between the brain and the rest of the body. Because lesions can occur in many different places, MS symptoms vary widely from one person to another.

The cause is not fully understood. Researchers believe MS results from a combination of genetic susceptibility and environmental factors. Low vitamin D levels, smoking and prior infection with Epstein-Barr virus have been linked to higher risk.

Early Symptoms of MS

Early symptoms often appear over hours to days, last at least a day and then improve partly or completely over weeks. Common first symptoms include:

• Vision problems: blurred or dim vision in one eye, washed-out colors and pain with eye movement, a condition called optic neuritis.
• Numbness or tingling in the face, body, arms or legs, often on one side or below a certain level of the trunk.
• Weakness or heaviness in a limb.
• Double vision or vertigo, caused by lesions in the brainstem.
• Balance problems and clumsiness.
• Electric-shock sensations running down the spine or limbs when bending the neck forward.
• Bladder urgency or frequency.
• Fatigue that is out of proportion to activity.
• Heat sensitivity, where symptoms temporarily worsen in a hot shower or on a hot day.
• Thinking changes, such as slower processing or difficulty multitasking.

Any of these symptoms can have other causes, which is why a neurological evaluation is needed rather than a self-diagnosis.

Types of MS

• Clinically isolated syndrome (CIS): a first episode of symptoms typical of MS that has not yet met the full criteria for diagnosis.
• Relapsing-remitting MS: the most common form at diagnosis, with attacks (relapses) followed by periods of recovery.
• Secondary progressive MS: after years of relapsing disease, some people experience gradual worsening with or without relapses.
• Primary progressive MS: steady progression from the start, often affecting walking.

How MS Is Diagnosed

There is no single test for MS. Neurologists diagnose it by showing evidence of damage in different areas of the central nervous system occurring at different times, and by ruling out other explanations.

Neurological history and examination

Your neurologist will review past episodes, even ones that seemed minor, and examine vision, eye movements, strength, reflexes, sensation, coordination and walking.

MRI

MRI of the brain and often the spinal cord is the most important test. It can reveal characteristic lesions, including some that have not caused symptoms, and contrast dye can show which lesions are active.

Other tests

• Blood tests to rule out conditions that can mimic MS, such as vitamin B12 deficiency, thyroid disease, infections and other autoimmune disorders.
• Spinal fluid analysis (lumbar puncture) to look for signs of immune activity in the nervous system, when the diagnosis is uncertain.
• Evoked potentials, which measure how quickly the brain responds to visual or sensory stimulation.
• Eye examination and optical coherence tomography to assess the optic nerve.

Treatment of MS

Treating relapses

Significant relapses are often treated with a short course of high-dose corticosteroids, which can speed recovery. Not every relapse requires treatment.

Disease-modifying therapies

Disease-modifying therapies reduce relapses and new MRI lesions and can slow disability. They include injectable medications, oral medications and infusion therapies. The choice depends on disease activity, safety considerations, other health conditions, pregnancy plans and personal preference. Many MS specialists favor starting treatment early, since inflammation can cause lasting damage even when symptoms are mild.

Managing symptoms

Fatigue, spasticity, bladder symptoms, nerve pain, mood changes and cognitive difficulties can all be treated. Physical and occupational therapy help maintain strength, balance and independence. Muscle stiffness may respond to stretching, medications and, in some cases, Botox injections. If concentration or memory is affected, computerized cognitive testing can measure the changes and track them over time.

Questions to Ask After an MS Diagnosis

Hearing the words "multiple sclerosis" can be overwhelming. Writing down questions before each visit helps you take an active role in decisions. Useful questions include:

• What type of MS do I have, and how active does it appear on MRI?
• Which disease-modifying therapies fit my situation, and what monitoring do they require?
• How should I recognize and report a relapse?
• How will MS and its treatment affect pregnancy or family planning?
• Which symptoms can be treated now, such as fatigue, bladder urgency or stiffness?
• How often will I need follow-up visits and MRI scans?

Living Well With MS

• Do not smoke. Smoking is associated with faster progression.
• Stay physically active with exercise suited to your abilities.
• Ask about vitamin D levels and supplementation.
• Manage heat with cooling strategies during hot weather.
• Keep regular follow-up, including periodic MRI scans to monitor disease activity.
• Look after your mental health; depression is common and treatable.

When to See a Neurologist

Make an appointment if you develop vision loss in one eye, numbness or weakness lasting more than a day, double vision or unexplained balance problems, especially if symptoms come and go. Sudden weakness, trouble speaking or facial drooping requires a call to 911, since these may be signs of a stroke.

Neurology Care in Westwood, NJ

Multiple sclerosis is among the neurological disorders our physicians are trained to investigate, diagnose and treat. A careful evaluation of new vision, sensory or balance symptoms is the first step toward an accurate answer. Learn more about our neurology services and physicians, or find directions on our contact page.

This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.