What are the symptoms of multiple sclerosis (MS)?

The signs and symptoms of MS will often differ to a great extent between patients. They are often unpredictable and range between mild and severe, short-term and long-term. Symptoms may manifest in a variety of ways and combinations, depending on the location of the nerve cells affected. The following is a list of the most commonly seen symptoms in patients suffering from multiple sclerosis³.

The initial symptoms of from multiple sclerosis (MS):

• Double or blurred vision
• Pain and temporary partial blindness in one eye due to inflammation of the optic nerve (optic neuritis)
• Red-green colour distortion
• Issues with walking (caused by muscle weakness or clumsiness of the leg)
• An abnormal pain or feeling, such as prickling and numbness (similar to pins and needles), known as paraesthesia that is experienced in the trunk, on one side of the face, or in one or more limbs³.
• Abnormal twitching of the facial muscles, known as facial myokymia (although this may also develop at a later stage)3

Other symptoms of MS include:

• Muscle weakness – This is generally experienced in the individual’s arms and legs
• Issues with coordination – The sufferer may experience problems with standing or walking, this may lead to partial or complete paralysis
• Spasticity – This refers to a condition wherein the muscles are increasingly contracted leading to stiffness and tightening thereof. Cramping and spasms are also experienced as a result.
• Fatigue – This is a commonly experienced symptom in MS and may occur particularly when partaking in physical activities and often easing with rest. However, the affected person may also suffer from chronic fatigue wherein they are permanently tired regardless of whether exerting themselves or not.
• Loss of sensation and feeling – this can occur in various parts of the body
• Speech issues
• Tremors
• Hearing loss
• Dizziness
• Bladder and bowel control issues
• Changes in libido and/or sexual dysfunction
• Depression
• Seizures (although these are not common)
• Heat sensitivity (intolerance)

Roughly 50 percent of patients with MS suffer from cognitive issues that are linked to the condition. These effects may be mild or severe and are often detected after professional testing. Cognitive issues may include the following:

• Issues with focusing and concentrating
• Difficulty in paying attention
• Finding it difficult to remember things (memory loss)
• Poor judgment and difficulty in decision-making

The symptoms of multiple sclerosis are often grouped into primary, secondary and tertiary categories as follows:

Primary symptoms of MS 

(These symptoms are caused by damage done to myelin)

• Numbness
• Weakness
• Tremors (shaking)
• Visual issues (vision loss, usually in one eye)
• Pain
• Balance issues
• Bowel and bladder issues
• Lhermitte sign (an electric-shock sensation – see below for a full explanation)
• Paralysis

Secondary symptoms

(These symptoms are complications that arise as a result of the aforementioned primary symptoms)

1. Paralysis may develop from weakness and numbness and can result in issues such as bed sores.
2. Reduced physical activity (or inactivity) may cause weakness and problems with breathing and/or result in poor posture due to issues with muscle imbalances, and lowered bone density.
3. A loss of mobility due to weakness and issues with swallowing can increase the affected individual’s risk of pneumonia.
4. Bladder issues may result in urge incontinence and/or urinary tract infections (these infections are often recurring).

Tertiary symptoms

These symptoms are seen as psychological, social and job-related issues that are experienced by patients with multiple sclerosis:

• A patient who is no longer able to drive may risk their livelihood (especially if they are in a field that requires them to have their own means of transport)
• The strain of having to deal with the physical and psychological effects of MS often has an adverse impact on one’s personal relationships
• Depression is commonly seen among those with MS, this can be debilitating in multiple areas and affect one’s quality of life, career and personal relationships.

What is Lhermitte sign?

Lhermitte sign (also known as barber chair sign) refers to painful sensations of electric-shock that travel down the back and into the limbs during specific neck movements, particularly when the sufferer bends their neck forward (i.e. flexes the neck)^4.

**My Med Memo - Lhermitte sign is named after the French neurologist Jean Lhermitte, this sign is often one of the first symptoms of multiple sclerosis. This phenomenon occurs as a result of damage to the myelin sheath disrupting signals from the brain to the rest of the body and as such, it is often the first sign of a number of neurological and spinal conditions including MS.

Sufferers describe this sensation as an intense burst of pain in the neck that travels through the body. With treatment or time, some people may spontaneously stop experiencing Lhermitte sign, therefore the condition is regarded as not life-threatening. 

When to see a doctor

It is advised that an individual should make an appointment with their doctor if they are experiencing any of the above signs and symptoms without there being a logical reason as to why.

How multiple sclerosis affects the body

Multiple sclerosis occurs when a sufferer’s immune system mistakenly attacks the cells of the central nervous system (known as oligodendrocytes) and the myelin sheath, a form of fatty material that protects the nerve fibres (axons) in the body. This attack and the resulting damage (known as demyelination) causes issues with nerve impulses (signals) and hinders the transmission of information within the brain and communication between it and the rest of the body.

In the early stages of multiple sclerosis, once inflammation as a result of the immune attack subsides (this is known as a period of remission), a process known as remyelination wherein the body attempts to replace the damaged myelin, may occur.  Whether or not this process is possible will depend on the degree of damage incurred by the oligodendrocytes. 

When remyelination is possible, the newly generated myelin surrounding the affected nerve cells is thinner than that of their unaffected counterparts and although it can function sufficiently, the affected nerves and impulses conducted by them may be slower than they once were. 

In time, as the condition progresses, and the body is unable to repair damaged myelin caused by repeated immune attacks and the resulting inflammation, deterioration of the nerves and eventually permanent damage to these occurs as their protective sheaths (myelin sheaths) are destroyed and scar tissue forms in their place¹ .  This scar tissue, referred to as ‘sclerosis’, appears as white areas on MRI scans and with multiple sclerosis, multiple lesions (scars) will be evident on the brain and/or spinal cord.

Because of this scarring, symptoms associated with multiple sclerosis (MS) such as muscle weakness, pins and needles, loss of sensation, and visual issues may begin to emerge. MS symptoms are often unpredictable and vary in their effects and intensity depending on the individual, the affected areas of the brain and spinal cord, and the degree of the scarring experienced.  

In response to the loss of nerve fibres (axons) caused by demyelination and in an attempt to compensate for this, the CNS will attempt to redirect nerve impulses to healthy nerve cells, thus bypassing the damaged areas and enabling the muscles to continue to function. This process is known as plasticity and while nerve impulses may be delayed by this process, it does help to improve symptoms to a degree.

When damaged areas become too large to bypass, plasticity is no longer effective and impulses to or from the affected area within the CNS become permanently blocked and symptoms no longer improve.

 

^References

^{1. Medicine Plus. August 2014. Multiple Sclerosis. Available: https://medlineplus.gov/multiplesclerosis.html [Accessed 25.08.2017]}

^{3. Health Encyclopaedia.  Multiple Sclerosis (MS). Available: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P00790 [Accessed 29.08.2017]}

^{4. April 2015. Lhermitte's Sign: The Current Status. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445188/ [Accessed 13.09.2017]}