Early Warning Signs of Multiple Sclerosis (MS)

By Colleen Doherty, MD

While no two people experience multiple sclerosis (MS) the same way, some symptoms tend to crop up earlier in the disease course than others. These symptoms may serve as warning signs of the disease, potentially allowing you or a loved one to receive a diagnosis of MS sooner than later.

In multiple sclerosis, your immune system goes awry and damages the fatty covering (myelin) that insulates nerve fibers within your central nervous system (CNS). Your CNS consists of your brain, spinal cord, and the optic nerves of your eyes.

As a result of myelin damage, nerve signals cannot be transmitted rapidly or efficiently between the CNS and the rest of your body. This can lead to various symptoms like blurry vision, pain, abnormal sensations, and muscle weakness, among many others.

This article reviews some of the common early symptoms and signs of MS. It also gives a brief overview of differences of MS between males and females and how MS is diagnosed.

Early Warning Signs

Two phenomena—clinically isolated syndrome and optic neuritis—may serve as early warning signs of MS. People who experience one (or both) of these may or may not go on to develop MS.

Clinically Isolated Syndrome

Clinically isolated syndrome (CIS) refers to a person’s first-time episode of neurological symptoms caused by inflammation and damaged myelin in the CNS.¹

As an example, a patient diagnosed with CIS may experience numbness and tingling in their legs. This would be accompanied by magnetic resonance imaging (MRI) findings that reveal damage to the CNS.

CIS is followed by a recovery period where the symptoms improve or completely go away.

Difference Between CIS and MS

The key difference between CIS and MS is that CIS is diagnosed after a person experiences one episode of neurological symptoms. MS can only be diagnosed when a person has experienced more than one episode of neurological symptoms.

Optic Neuritis

Optic neuritis—inflammation of one of your two optic nerves—is a common first presentation of MS. In fact, CIS may be diagnosed from an attack of optic neuritis.

Your optic nerve delivers messages to your brain about what your eye sees. When the myelin covering the optic nerve is damaged, signals related to sight are interrupted.

The common symptoms of optic neuritis include pain with eye movements, blurry or “foggy” vision, and seeing colors less vividly. Vision symptoms usually improve and fully recover within three to five weeks. That said, up to 10% of patients may experience long-term vision problems.²

Most Common Symptoms

Even though the symptoms of MS vary in type, severity, and duration, there are some that are more common than others. The following is a brief snapshot of such symptoms:³

Vision Problems

Besides optic neuritis, other common vision problems seen in MS are:⁴

• Nystagmus is uncontrolled, jerking movement of the eyes, sometimes referred to as “dancing eyes.” This symptom is caused by damage to the area of the brainstem that controls eye movements.
• Diplopia (double vision) is uncoordinated eye movements that cause you to see double. This symptom results from damage to the nerves that control your eye muscles.

Muscle Spasms

Muscle spasms are common in MS and are primarily caused by damaged myelin in the nerves that innervate or connect to your muscles. As a result of disrupted nerve signals, your muscles cannot relax properly. This causes muscle stiffness and/or a tightening, cramping, or heavy sensation in the affected muscle(s).

The legs are most commonly affected by spasms, but they can occur anywhere in the body. Muscle spasms also tend to be asymmetric, meaning they are more likely to happen on one side of the body versus both sides.

Pain

Nerve fiber damage in MS causes neuropathic pain, which is associated with burning, stabbing, sharp, itching, or squeezing sensations. This type of pain is associated with disability, depression, and fatigue in MS.⁵

Specific types of neuropathic pain that may be early signs of MS include:

• Lhermitte’s sign is a sensation of electricity that runs down your spine when you touch your chin to your chest. In MS, it’s caused by damage to nerve fibers in your upper spine.
• MS hug is a tightening sensation around the chest and ribs caused by damage to the nerve fibers in your spine.
• Trigeminal neuralgia is an electric-shock-like or stabbing pain in the face or jaw area that is caused by damage to the trigeminal nerve (the fifth cranial nerve).

Fatigue and Weakness

MS fatigue is often felt both physically and mentally. Described by many as “having the flu,” MS fatigue is not eased by sleep and tends to come on suddenly and worsen with heat and humidity.

The overwhelming exhaustion and depletion of energy seen with MS fatigue may arise from the disease itself and/or other factors like medications, sleep disorders, or depression.

Timeline of MS Fatigue

Fatigue can occur at any time during the course of MS, and its development is not necessarily related to the progression of more objective neurological symptoms (e.g., walking problems).⁶

Weakness is also common in MS and may arise from damage to the nerve fibers in the CNS that normally control muscle movements. Lack of activity due to MS-related pain, fatigue, or other symptoms can also contribute to MS weakness.

Bladder and Bowel Problems

Bladder dysfunction is common in MS, affecting the majority of patients at some point in the course of their disease. Urinary symptoms as the first presentation of MS occur in around 3% to 10% of people.⁷

Symptoms and signs of bladder dysfunction in MS vary from mild to severe. They may include:

• Urgency: Feeling like you have to urinate right away
• Hesitancy: Having trouble initiating urination or you cannot maintain a steady stream
• Nocturia: Having to urinate often at night
• Incontinence: Having an involuntary loss of urine control

Recurrent urinary tract infections may also be a sign of bladder dysfunction in MS.

Bowel problems are common in MS, with constipation being the most frequent complaint. Constipation can aggravate other MS symptoms including muscle spasms, pain, bladder dysfunction, and walking problems. It can also contribute to fecal incontinence, which is the loss of control of your bowels.

Depression and Emotional Changes

Depression is associated with constant sadness and a lack of interest in activities you once enjoyed. In MS, depression can occur at any time in the course of the disease, including early or later on.

Depression in MS may stem from a number of different factors, including:

• MS itself: Damage to the areas of the brain that regulate emotion
• Side effects of MS medications: For example, corticosteroids (used to treat MS relapses) and interferon drugs (used as disease-modifying therapies)
• Stress associated with living with MS: Undergoing a new diagnosis, relapse, or major change in function.

Other common emotional symptoms in MS include grief, anxiety, irritability, and anger. Many of these emotions stem from the unpredictable nature of MS, and the physical and emotional impact the disease has on a person’s life.

 Read: Emotional and Psychological Symptoms in Multiple Sclerosis

Presentation in Males vs. Females

Differences exist in MS in males and females.⁸ For instance, research has found that females are twice as likely to live with MS as males. Moreover, those diagnosed with primary progressive MS (PPMS) are more likely to be male.

What Is PPMS?

PPMS is characterized by worsening symptoms from the onset of the disease. People with PPMS do not experience relapses or periods of symptom improvement (“remission”).

Experts haven’t yet teased out fully why these differences between sexes exist. Sex hormones, pregnancy, social factors (delayed care-seeking behavior), and/or differences in genes or environmental exposures may be involved.⁹

How MS Is Diagnosed

The diagnosis of MS is often challenging, considering the symptoms are so variable. In addition, symptoms early on can often be vague or mimic those of other conditions, such as systemic lupus erythematosus (SLE) (an autoimmune disease that can affect many body systems) or vitamin B12 deficiency.

A neurologist—a doctor who specializes in diseases of the nervous system—will use the following tools to confirm a diagnosis of MS:¹⁰

• Your medical history and neurological exam
• The McDonald criteria (a set of guidelines that focuses on diagnosing MS by showing evidence of damage to the CNS at different dates and to different parts)
• Magnetic resonance imaging (MRI) of the brain and spinal cord (which uses strong magnets to produce detailed images)
• Laboratory tests, mostly to rule out other conditions
• Other tests, including a spinal tap (lumbar puncture) and evoked potential tests (which measure electrical activity of the nerves of the eye)

Read: Diseases That Can Mimic Multiple Sclerosis

Video: “Rehabilitation of the patients with Multiple Sclerosis”

Multiple Sclerosis. Exercises for stretching and improving body flexibility and joint mobility, reducing tone.

For additional information about Rehabilitation of the patients with Multiple Sclerosis you can watch a video demonstrating exercises and rehabilitation recommendations.

Check out the demo version of our sets of exercises for Multiple Sclerosis on YouTube

You can find more information about  Multiple Sclerosis in our Blog.

Our website presents the following sets of exercises for the rehabilitation of the patients with Multiple Sclerosis:

1. MULTIPLE SCLEROSIS. EXERCISES FOR STRETCHING AND IMPROVING BODY FLEXIBILITY AND JOINT MOBILITY, REDUCING TONE

2. MULTIPLE SCLEROSIS. EXERCISES TO STRENGTHEN THE MUSCULOSKELETAL AND MUSCULAR SYSTEM, ENDURANCE

3. MULTIPLE SCLEROSIS. EXERCISES TO IMPROVE COORDINATION, BALANCE AND GAIT

4. MULTIPLE SCLEROSIS. STRETCHING AND WORKING WITH A MASSAGE ROLLER. ADVANCED STAGE OF REHABILITATION

Summary

Even though no two people experience MS in the same way, there are some symptoms, including vision problems and sensory disturbances, that may serve as early warning signs of the disease. Other common symptoms of MS include fatigue, muscle spasms, pain, bladder problems, and constipation.

Conclusion

If you are concerned that you may be experiencing possible symptoms of MS, schedule an appointment with your healthcare provider or a neurologist. Diagnosing and treating MS as early as possible is associated with better long-term outcomes.

Keep in mind that many symptoms of MS overlap with other common medical conditions. Be proactive and get checked out, but try not to worry yourself until you know more information.

By Colleen Doherty, MD
Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.

FREQUENTLY ASKED QUESTIONS

• What age does MS usually start?

Most people are diagnosed with MS between the ages of 20 and 50 years old. That said, MS can develop at any age, and symptoms may predate a diagnosis by years.

• Can you have MS for years and not know it?

Yes. In fact, research suggests MS may have a prodromal (“very early”) phase. This phase includes various nonspecific symptoms, like fatigue, depression, pain, and headache. These symptoms may precede an MS diagnosis by several years.¹¹

• Can a blood test show MS?

There is no blood test that can diagnose MS. If you or a loved one are being evaluated for MS, your neurologist will use a variety of diagnostic tools, including your medical history, neurological exam, an MRI, and various blood or spinal fluid tests.

• Will MS show up on an MRI?

MS occurs when your immune system mistakenly attacks myelin, a protective coating on your nerves. These attacks lead to inflammation in the brain and spinal cord. The inflammation shows up as “lesions” or “plaques” on an MRI.

Sources

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4. National MS Society. Vision problems in multiple sclerosis.
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6. Tur C. Fatigue management in multiple sclerosis. Curr Treat Options Neurol. 2016;18:26. doi:10.1007/s11940-016-0411-8
7. Aharony SM, Lam O, Corcos J. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines. Can Urol Assoc J. 2017;11(1-2):61–64. doi:10.5489/cuaj.4058
8. Walton C, Rechtman L. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler. 2020 Dec; 26(14): 1816–1821. doi:10.1177/1352458520970841
9. Eccles A. Delayed diagnosis of multiple sclerosis in males: may account for and dispel common understandings of different MS ‘types.’ Br J Gen Pract. 2019;69(680):148–149. doi:10.3399/bjgp19X701729
10. Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis of multiple sclerosis: progress and challenges. Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-X
11. DiSanto G, Zecca C, MacLachlan S et al. Prodromal symptoms of multiple sclerosis in primary care. Ann Neurol 2018;83(6):1162-1173. doi:10.1002/ana.25247