Multiple Sclerosis (MS)


Multiple sclerosis (MS) can lead to a variety of symptoms affecting many parts of the body.1,2 These symptoms vary widely between patients. In some, they may relapse and remit, as in the case of relapsing-remitting multiple sclerosis, while in patients with progressive multiple sclerosis they may worsen gradually. 

The most common MS symptoms include fatigue, vision impairments, numbness and tingling, muscle spasms, stiffness, weakness, mobility issues, pain, cognitive dysfunction, anxiety and depression, sexual dysfunction, bowel and bladder problems, dysphagia, and dysarthria. Other rarer symptoms include seizures, breathing issues, and hearing loss. 

MS and Fatigue

Fatigue is among the most common MS symptoms, having a considerable negative effect on patients’ quality of life.3

MS and Vision Impairments

Multiple sclerosis lesions can affect the optic nerve, causing optic neuritis.4 This can lead to a number of vision problems, including loss of vision in one or the other eye, color blindness, pain in the eye, light flashes, double vision, and involuntary eye movements.1

Vision impairments are often the first of multiple sclerosis symptoms, affecting approximately 1 in 4 patients.5 In relapsing-remitting multiple sclerosis, the vision problems may disappear and reappear in time. In some cases, they may affect both eyes at the same time.

Numbness and Tingling

MS can lead to numbness and tingling in different parts of the body, including the higher and lower extremities, and trunk. These sensations typically spread over several days and may subside.1

Muscle Spasms, Stiffness, and Weakness

Muscle spasms, stiffness, and weakness can occur in any part of the body and can be mild or severe. They are caused by damage to the nerve fibers leading to an impairment in nerve impulses.6

MS and Mobility Issues

Mobility issues caused by MS include walking difficulties such as a swaying gait, balance problems, and frequent falls.7 Other mobility issues include clumsiness, tremor, dizziness, and vertigo.

MS and Pain

Pain in MS originates from different sources. Neuropathic pain is the result of damage to the nervous system and can appear in the form of stabbing pain in the face or other parts of the body such as the limbs and trunk. Pain can also be caused by muscle spasms and spasticity. MS can also cause indirect pain in the back, neck, and joints especially in patients who are having mobility issues.1

MS and Cognitive Dysfunction

Nerve damage caused by MS can lead to several problems affecting cognition, such as information processing, memory, attention and concentration, executive functioning, visuospatial functioning, and verbal fluency.8,9 The disease may affect 1 or more areas of cognition and the symptoms can be mild or severe.

MS and Mental Health

Anxiety and depression affect many patients with MS.10 It is not clear whether they are directly caused by the neuropathologic changes of the disease itself or are a consequence of having to live with a chronic disease and uncertainty about the future.

Other mental health issues that patients with MS may experience include mood swings and sudden bursts of emotions without apparent reason.1

Sexual Dysfunction in MS

In men, sexual dysfunction can manifest in the form of erectile dysfunction and inability to ejaculate. Women may experience decreased vaginal lubrication and sensation, as well as difficulty reaching an orgasm.11

Bladder and Bowel Problems with MS

Bladder and bowel problems in MS can develop as a result of lesions blocking or delaying the transmission of nerve signals in the brain and spinal cord which control the bladder and bowels. 

Bladder issues are very common and affect approximately 80% of MS patients.12 They may include urinary urgency, hesitancy at onset of urination, nocturia, incontinence, and urinary retention. Urinary tract infections are also common.

Common bowel issues in MS include constipation and bowel incontinence.13

Dysphagia and Dysarthria in MS

Patients with MS may experience dysphagia and/or dysarthria. 

Dysphagia can be caused by damage to the nerves that control the muscles in the mouth and throat. Numbness of the mouth and throat can also lead to dysphagia.14

Dysarthria can be caused by lesions in the cerebellum and can include scanning dysarthria, slurred speech, and nasal speech. The disease can also impair the ability to control speech volume.15

MS and Seizures

Patients with MS may have an increased risk of having seizures, compared with people without the disease, but the exact cause of this is not known.16

Breathing Issues and MS

Breathing issues are rare in MS because the disease rarely affects the autonomic nervous system.17 However, muscle weakness can occur in respiratory muscles and may cause breathing difficulties in some patients.

MS and Hearing Loss

Although rarely permanent, temporary sensorineural hearing loss may occur in 4% to 10% of patients with MS.18 Sudden hearing loss could be the result of demyelinating plaques in the pons or pontocerebellar area. If sudden hearing loss is caused by MS, it usually resolves completely.

References

1. Symptoms – Multiple sclerosis. NHS. Accessed June 11, 2021.

2. MS symptoms. National Multiple Sclerosis Society. Accessed June 11, 2021.

3. Braley TJ, Chervin RD. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep. 2010;33(8): 1061-1067. doi:10.1093/sleep/33.8.1061

4. Kale N. Optic neuritis as an early sign of multiple sclerosis. Eye Brain. 2016;8:195-202. doi:10.2147/EB.S54131

5. Vision problems. National Multiple Sclerosis Society. Accessed June 11, 2021.

6. Spasticity and spasms. Multiple Sclerosis Trust. Accessed June 11, 2021.

7. Mobility and walking issues. Multiple Sclerosis Association of America. Accessed June 11, 2021.

8. Nabavi SM, Sangelaji B. Cognitive dysfunction in multiple sclerosis: usually forgotten in the clinical assessment of MS patients. J Res Med Sci. 2015;20(5):533-534. doi:10.4103/1735-1995.163984

9. Cognitive changes. National Multiple Sclerosis Society. Accessed June 11, 2021.

10. Beiske AG, Svensson E, Sandanger I, et al. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurol. 2008;15(3):239-45. doi:10.1111/j.1468-1331.2007.02041.x 

11. Sexual dysfunction in multiple sclerosis. Cleveland Clinic. Accessed June 11, 2021.

12. Khalaf KM, Coyne KS, Globe DR, et al. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi:10.7224/1537-2073.2013-040

13. Preziosi G, Gordon-Dixon A, Emmanuel A. Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degener Neurol Neuromuscul Dis. 2018;8:79-90. doi:10.2147/DNND.S138835

14. Swallowing problems. National Multiple Sclerosis Society. Accessed June 11, 2021.

15. Speech problems. National Multiple Sclerosis Society. Accessed June 11, 2021.

16. Kelley BJ, Rodriguez M. Seizures in patients with multiple sclerosis: epidemiology, pathophysiology and management. CNS Drugs. 2009;23(10):805-815. doi:10.2165/11310900-000000000-00000 

17. Breathing problems. National Multiple Sclerosis Society. Accessed June 11, 2021.18. Tekin M, Ozbilen Acar G, Cam OH, Hinge FM. Sudden sensorineural hearing loss in a multiple sclerosis case. North Clin Istanb. 2014;1(2):109-13. doi:10.14744/nci.2014.35744

Reviewed by Michael Sapko, MD, on 7/1/2021

Reviewed by Michael Sapko, MD, on 7/1/2021.

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