The initial symptoms of multiple sclerosis are typically:

• difficulty in walking
• abnormal sensations such as numbness or a feeling of "pins and needles"
• pain and loss of vision due to optic neuritis (inflammation of the optic nerve)

Less common initial symptoms may include:

• tremor
• incoordination (lack or loss of coordination)
• slurred speech or other speech disorders
• sudden onset of paralysis, similar to a stroke
• a decline in cognitive function, the inability to think, reason, and remember

It is useful to divide multiple sclerosis symptoms into primary, secondary and tertiary categories. For example, bladder and bowel dysfunction often occur after the onset of multiple sclerosis.

Primary symptoms: are a direct result of demyelination, the destruction of the fatty myelin sheath that surrounds and insulates nerve fibers in the central nervous system. This impairs transmission of nerve impulses to muscles and other organs. The symptoms include weakness, numbness, tremor, loss of vision, pain, paralysis, loss of balance, and bladder and bowel dysfunction. Many of these symptoms can be managed effectively with medication, rehabilitation, and other medical treatments.

Secondary symptoms are complications that arise as a result of the primary symptoms. For example, bladder dysfunction can cause repeated urinary tract infections. Inactivity can result in weakness from lack of muscle use (not related to demyelination), poor postural alignment and trunk control, muscle imbalances (adaptive shortening and/or stretch weakness), decreased bone density (osteoporosis increasing risk of fracture), and shallow, inefficient breathing. Paralysis can lead to the secondary symptom of bedsores. While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.

Tertiary symptoms: are the social, vocational and psychological complications of the primary and secondary symptoms. A person who becomes unable to walk or drive may lose his or her livelihood. The strain of dealing with a chronic illnesses caused by MS may disrupt personal relationships. Depression is frequently seen among people with multiple sclerosis. Depression may be a primary, secondary, or tertiary symptom. Professional assistance from psychologists, social workers, physical and occupational therapists, and public health agencies is indicated for managing many tertiary symptoms.

Other symptoms of multiple sclerosis may include:

• dizziness and vertigo
• dysphagia (difficulty in swallowing)
• headache
• hearing problems
• itching
• numbness
• pain
• seizures
• loss of sexuality or sexual problems
• spasticity (stiffness)
• tremor

Many of the symptoms of multiple sclerosis can be effectively managed and complications can be avoided with regular care by a neurologist and other health professionals on the diagnosis and treatment team.

Updated: September 18, 2007

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