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What 're the signs and symptoms of multiple sclerosis?

The symptoms of multiple sclerosis can be different from person to person. Visual, sensory, and motor signs and symptoms are all part of multiple sclerosis. Some people have mild cases of multiple sclerosis with little or no disability. Others have full-blown multiple sclerosis that confines them to a bed or wheelchair. Still others are only diagnosed with

multiple sclerosis after their death and live their entire lives symptom free. This variability makes it extremely difficult to diagnose multiple sclerosis. Often the signs and symptoms are mistaken as psychiatric in origin.

Affected individuals may experience a wide variety of symptoms, such as vision loss, double vision, nystagmus, difficulty with speech, various kinds of tremor, clumsiness of the hands, unsteady gait, weakness, spasticity, numbness, and bladder, bowel, as well as sexual dysfunction. Various cognitive impairments are also common, such as difficulty performing multiple tasks at once, difficulty following detailed instructions, loss of short term memory, depression, and fatigue.

The symptoms of multiple sclerosis may occur in one of three patterns. The most common pattern is the "relapsing-remitting" pattern, in which there are clearly defined symptomatic attacks lasting 24 hours or more, followed by complete or almost complete improvement. The period between attacks may be a year or more at the beginning of the disease, but may shrink to several months later on. This pattern is especially common in younger people who develop multiple sclerosis. In the "primary progressive" pattern, the disease progresses without remission or with occasional plateaus or slight improvements. This pattern is more common in older people. In the "secondary progressive" pattern, the person with multiple sclerosis begins with relapses and remissions, followed by more steady progression of symptoms.

The first symptoms of multiple sclerosis are often visual changes. A large number of people with multiple sclerosis develop optic neuritis, which is described as painful vision loss. If you are diagnosed with optic neuritis early, treatment could change the course of the disease. Before actual loss of vision, you may have visual changes described by many people as blurred or hazy vision, flashing lights, or alterations in color. The tissues around your eye and moving your eye may be painful. Most people recover over several months. Others are left with permanent visual defects. Double vision occurs when eyes move different directions and is another common symptom of multiple sclerosis.

Later symptoms may include fatigue, muscle spasticity and stiffness, tremors, paralysis, pain, vertigo, speech or swallowing difficulty, loss of bowel and bladder control, incontinence, constipation, sexual dysfunction, cognitive changes. Weakness in one or both legs is common, and may be the first symptom noticed by a person with multiple sclerosis. Muscle spasticity, or excessive tightness, is also common and may be more disabling than weakness. Muscle weakness can involve the extremities (arms and legs) on one side of the body (called hemiparesis), both legs (called paraparesis), or all four extremities (called quadraparesis). Muscles in the affected area may tighten (called spasticity) and contract spontaneously (called spasm or clonus).

Many people with multiple sclerosis experience fatigue and need to rest and sleep during the day in order to continue their activities. The degree of fatigue may not be related to the severity of other symptoms. An increase in body temperature (e.g., caused by hot weather, hot bath and showers, or fever) can worsen symptoms or produce new ones. This occurs because elevated body temperature slows nerve impulse conduction, especially in demyelinated nerves. Double vision or eye tremor (nystagmus) may result from involvement of the nerve pathways controlling movement of the eye muscles. Visual disturbances result from involvement of the optic nerves (optic neutritis) and may include development of blind spots in one or both eyes, changes in color vision, or blindness. Optic neuritis usually involves only one eye at a time and is often associated with movement of the effected eye.

More than half of all people affected by multiple sclerosis have pain during the course of their disease, and many experience chronic pain, including pain from spasticity. Acute pain occurs in about 10% of cases. This pain may be a sharp, stabbing pain especially in the face, neck, or down the back. Facial numbness and weakness are also common. Cognitive changes, including memory disturbances, depression, and personality changes, are found in people affected by multiple sclerosis, though it is not entirely clear whether these changes are due primarily to the disease or to the psychological reaction to it. Depression may be severe enough to require treatment in up to 25% of those with multiple sclerosis. A smaller number of people experience disease-related euphoria, or abnormally elevated mood, usually after a long disease duration and in combination with other psychological changes. Symptoms of multiple sclerosis may be worsened by heat or increased body temperature, including fever, intense physical activity, or exposure to sun, hot baths, or showers.

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