The first symptoms of MS are often problems with your eyes (optic neuritis) or a prickling, stabbing pain in your face that doctors call trigeminal neuralgia. Other common symptoms include tremors, changes to your speech and swallowing and fatigue that causes you to feel exhausted throughout the day.
Symptoms vary from person to person and can come and go. They can also interact with each other.
1. Numbness or tingling
Numbness or tingling is one of the most common first symptoms of MS. It can occur in any part of the body, including the head, neck, arms and legs. It usually happens on both sides of the body, but sometimes only one side. If it occurs suddenly or is intense, get medical help right away. It could be a sign of a brain or spinal cord problem that needs to be treated quickly.
You might also notice clumsiness or trouble walking. This can be a result of nerve demyelination, and it can cause you to stumble or trip. It can also be a sign of a problem with the parts of your brain that direct your muscles (ataxia).
Everyone feels numbness or tingling at some time, such as when they stand up after sitting for a long time. But these feelings don’t last very long and go away when you move your leg or arm again. In MS, the numbness or tingling is different. It doesn’t go away and can keep getting worse (called RRMS with progression). It can also be a sign of PPMS, in which your symptoms gradually get worse from the start of your disease (no period of remission).
To diagnose MS, doctors review your symptoms and do a physical examination. They will ask you questions about when the numbness or tingling started and what makes it better or worse. They will also do tests to find the disorder that’s causing it. These may include blood tests and imaging studies such as CT scans or MRI of your brain and spine. Nerve conduction studies are also possible, in which a health care provider places electrodes on the affected nerve or muscle. These send a small electric pulse through your nerve to see if it transmits the signal at normal speed.
2. Loss of coordination or balance
A common early symptom of MS is problems with balance and walking. These may occur because of weakness in the muscles that stimulate your feet, ankles and legs (known as spasticity), or because of the damage to nerves that control these movements. It is also possible that you will lose the ability to coordinate these muscle actions, a condition called ataxia.
If you are experiencing loss of coordination or balance, ask your GP for advice. They can arrange tests to see if the symptoms are caused by MS or another health problem. If your GP thinks you may have MS, they will refer you to a specialist in conditions of the nervous system (a neurologist).
The nerve damage that occurs in people with MS can affect a range of other body functions. Some of these may be very serious.
These include:
Fatigue – an inexplicable mental and physical exhaustion that goes beyond being tired. Watch Helena, Caroline and Daf Wyn explain their experiences of fatigue here
Difficulty swallowing – if the nerves that help you control your mouth, tongue and throat are affected, it can make it hard to swallow and increase your risk of choking.
Changes to speech and voice quality – Nerve damage in the area that controls the muscles of your mouth and throat can cause a range of changes including slurred or hoarse voice, difficulty with pronunciation or a cough when eating.
Problems with vision can be a very early symptom of MS, especially in cases where the disease progresses faster than normal. This is because of a type of MS known as Marburg variant or Balo’s concentric sclerosis which causes rapid progression.
3. Muscle spasms or weakness
A variety of muscle problems can occur in MS, but they vary greatly from person to person and can fluctuate throughout the day. They may involve stiffness (spasticity) or spasms, a sudden involuntary tightening of muscles causing them to contract and shorten. This can be very painful and can make it difficult to move or sleep. It can also cause you to feel weak and unsteady on your feet. These symptoms affect 40–80% of people with MS.
Spasms are a type of muscle cramp that can happen in any part of the body, but are often felt most strongly in the legs. They can be very painful and can jerk the legs so much that they wake you up at night or leave you stuck in an uncomfortable position such as lying flat on your back with your leg bent at an odd angle. This is called clonus.
In around 1 in 4 cases of MS, the first noticeable symptom is changes to one or both of your eyes (optic neuritis or double vision). Some people with MS also have problems with their bladder and bowel such as trouble passing urine or being unable to empty their bladder completely. Others experience fatigue, which can significantly reduce your ability to work and tends to get worse in hot weather or after exercise.
Because MS attacks axons in the central nervous system, it can damage the nerve pathways that send messages to and from other parts of your body. This is why your symptoms can be so unpredictable, and why it’s impossible to say exactly which parts of your body will be affected. It’s also why it’s very important to see a GP if you think you might have MS – it can be a complicated disease, and your GP will want to rule out any other possible causes of your symptoms.
4. Dizziness or vertigo
Many people have short episodes of feeling lightheaded or unsteady, but it’s usually not a sign of a serious disorder. It’s often caused by a temporary drop in blood pressure when you get up from a chair or bed, by dehydration from fever, vomiting or diarrhea, or by taking some medications.
But dizziness or vertigo that lasts for more than a few minutes, is recurrent and interferes with your normal activities could be a sign of a condition that affects the inner ear or the vestibular system, which helps you sense motion and balance. Benign paroxysmal positional vertigo (BPPV) is one common inner ear condition that causes dizziness. It happens when tiny bits of calcium in part of your inner ear get loose and move to places they don’t belong, sending the brain incorrect signals that make you feel like the world is spinning around you. Other conditions that can cause vertigo include viral infections that affect the vestibular nerve or labyrinthitis, a hearing loss that occurs in one ear.
Your doctor will ask you questions about your symptoms and do a physical exam. Then they may order a magnetic resonance imaging (MRI) or other tests that can reveal the cause of your dizziness. If your symptoms are sudden and severe, or if you have warning signs like weakness in one side of your body, they might need to do other tests right away, such as a Fukuda-Unterberger test to measure how well you’re able to walk, or a spinal tap (lumbar puncture) to check cerebrospinal fluid for signs of MS. If they do, your doctor will talk to you about the best treatment plan for you.
5. Loss of vision
A loss of vision is one of the first symptoms in around 1 in 4 people with MS, usually in just one eye. This happens when the optic nerve gets damaged from inflammation (optic neuritis). You might experience blurred or ‘washed-out’ colour vision and eye pain for a few days, per the National Multiple Sclerosis Society (NMSS). In most cases, your vision will improve once the inflammation goes away.
Another common eye problem with MS is a rhythmic bounce or jerkiness of the eyes, called nystagmus. This symptom can make it hard to focus on anything or can feel like the world is moving when you’re sitting still. It’s often seen on an MRI or CT scan and may be caused by damage to the part of your brain that controls the muscles that move your eyes, per the NMSS.
Your healthcare provider will check your vision with a visual acuity test, in which they’ll ask you to read letters at a specific distance on an eye chart. They may also use other tests, such as visual evoked potentials, to capture your nerves’ responses to different stimuli.
Symptoms of MS vary between people, so it’s important to keep a diary and see your doctor about any changes that you notice. In some cases, your vision problems will go away as the inflammation in your nerves settles down or if you’re lucky enough to have RRMS with periods of remission, but they could get worse over time if you have SPMS. Early treatment can slow this progression. It’s also worth remembering that some eye and vision problems are not related to MS and can be due to other conditions, such as glaucoma or watery eyes.
