What are the early warning signs of Multiple Sclerosis. How does MS affect the nervous system. What are the primary, secondary, and tertiary symptoms of MS. When should you see a doctor for MS symptoms.

Understanding Multiple Sclerosis: A Comprehensive Overview

Multiple Sclerosis (MS) is a complex neurological disorder that affects the central nervous system. It typically manifests between the ages of 20 and 40, with symptoms that can vary widely from person to person. The disease is characterized by the immune system mistakenly attacking the protective sheath (myelin) that covers nerve fibers, leading to communication problems between the brain and the rest of the body.

MS symptoms can be unpredictable, with some individuals experiencing mild symptoms that come and go, while others may face more severe, long-lasting effects. Understanding the early warning signs and various symptom categories is crucial for timely diagnosis and effective management of the condition.

Early Warning Signs: Recognizing the Initial Symptoms of MS

The initial symptoms of Multiple Sclerosis can be subtle and easily overlooked. However, recognizing these early warning signs is crucial for prompt diagnosis and treatment. Some of the most common early indicators include:

• Numbness and tingling sensations
• Vision problems
• Fatigue
• Balance and coordination issues
• Cognitive changes

One of the earliest signs of MS is often a condition called Clinically Isolated Syndrome (CIS). CIS is characterized by a single episode of neurological symptoms that lasts at least 24 hours. This episode is caused by inflammation or demyelination in the central nervous system.

Types of Clinically Isolated Syndrome

There are two main types of CIS:

1. Monofocal episode: This involves a single symptom caused by damage in one area of the central nervous system.
2. Multifocal episode: This involves multiple symptoms caused by damage in more than one area of the central nervous system.

While experiencing CIS doesn’t necessarily mean a person will develop MS, it does increase the likelihood. If an individual experiences another CIS or develops other MS symptoms later, doctors may perform an MRI to look for additional lesions indicative of MS.

Primary Symptoms of Multiple Sclerosis: Understanding the Core Manifestations

The primary symptoms of Multiple Sclerosis are directly related to the damage of myelin in the central nervous system. These symptoms can vary greatly from person to person and may fluctuate over time. Some of the most common primary symptoms include:

Fatigue

Fatigue is one of the most common and debilitating symptoms of MS. It can significantly impact a person’s daily life and ability to perform routine tasks. MS-related fatigue is often described as an overwhelming sense of exhaustion that is not proportional to the amount of activity performed.

Vision Problems

Visual disturbances are often among the first noticeable symptoms of MS. These can include:

• Optic neuritis: Inflammation of the optic nerve that can cause pain and temporary vision loss
• Double vision
• Blurry vision
• Color vision changes

Numbness and Tingling

Sensory disturbances such as numbness and tingling (paresthesia) are common in MS. These sensations can occur in various parts of the body, including the face, arms, and legs. They may be mild or severe and can interfere with daily activities.

Mobility Issues

MS can affect a person’s ability to move and coordinate their body. This can manifest as:

• Difficulty walking
• Balance problems
• Muscle weakness
• Spasticity (muscle stiffness and involuntary muscle spasms)

Cognitive Changes

Many people with MS experience cognitive changes, which can include:

• Memory problems
• Difficulty concentrating
• Slowed information processing
• Challenges with problem-solving and decision-making

Secondary Symptoms: The Ripple Effects of MS

Secondary symptoms of Multiple Sclerosis are those that arise as indirect consequences of the primary symptoms. These can include:

Bladder and Bowel Dysfunction

Many individuals with MS experience problems with bladder and bowel control. This can manifest as:

• Increased frequency of urination
• Urgency to urinate
• Difficulty emptying the bladder completely
• Constipation
• Bowel incontinence

These issues can significantly impact quality of life and may lead to social isolation if not properly managed.

Sexual Dysfunction

MS can affect sexual function in both men and women. This may include:

• Decreased libido
• Difficulty achieving orgasm
• Erectile dysfunction in men
• Vaginal dryness in women

Open communication with healthcare providers and partners is crucial in addressing these issues.

Pain

While MS itself is not typically painful, many people with the condition experience pain as a secondary symptom. This can include:

• Neuropathic pain (caused by damage to the nerves)
• Musculoskeletal pain (resulting from changes in posture or gait)
• Spasticity-related pain

Pain management strategies may include medications, physical therapy, and alternative therapies.

Tertiary Symptoms: The Social and Psychological Impact of MS

Tertiary symptoms of Multiple Sclerosis are the social, vocational, and psychological complications that can arise from living with a chronic illness. These symptoms can have a profound impact on an individual’s overall well-being and quality of life.

Depression and Anxiety

Living with MS can take an emotional toll. Many individuals experience depression and anxiety as they cope with the challenges of the disease. These mental health issues can be caused by:

• The unpredictable nature of MS
• Changes in lifestyle and independence
• Neurological changes in the brain
• Side effects of medications

It’s essential for individuals with MS to have access to mental health support and resources to address these challenges.

Social Isolation

The physical limitations and fatigue associated with MS can lead to social isolation. Individuals may find it challenging to maintain relationships or participate in social activities. Strategies to combat social isolation include:

• Joining MS support groups
• Utilizing technology to stay connected with friends and family
• Engaging in adaptive recreational activities

Vocational Challenges

MS can impact an individual’s ability to work, leading to vocational challenges. These may include:

• Difficulty maintaining full-time employment
• Need for workplace accommodations
• Career changes or early retirement

Vocational rehabilitation services can help individuals with MS navigate these challenges and find suitable employment options.

Managing MS: Treatment Approaches and Lifestyle Modifications

While there is no cure for Multiple Sclerosis, various treatment approaches and lifestyle modifications can help manage symptoms and slow disease progression. The management of MS typically involves a multidisciplinary approach, including:

Disease-Modifying Therapies (DMTs)

DMTs are medications designed to reduce the frequency and severity of MS relapses and slow the progression of the disease. These may include:

• Injectable medications (e.g., interferons, glatiramer acetate)
• Oral medications (e.g., fingolimod, dimethyl fumarate)
• Infusion treatments (e.g., natalizumab, ocrelizumab)

The choice of DMT depends on various factors, including the type of MS, disease activity, and individual patient characteristics.

Symptom Management

Various medications and therapies can help manage specific MS symptoms, such as:

• Muscle relaxants for spasticity
• Pain medications
• Medications for bladder and bowel dysfunction
• Antidepressants for mood disorders

Rehabilitation Therapies

Rehabilitation plays a crucial role in maintaining function and improving quality of life for individuals with MS. This may include:

• Physical therapy to improve mobility and strength
• Occupational therapy to assist with daily activities
• Speech therapy for communication and swallowing difficulties
• Cognitive rehabilitation for cognitive impairments

Lifestyle Modifications

Certain lifestyle changes can help manage MS symptoms and improve overall well-being:

• Regular exercise and physical activity
• Stress management techniques (e.g., meditation, yoga)
• Healthy diet and nutrition
• Adequate rest and sleep
• Avoiding triggers (e.g., heat exposure)

When to See a Doctor: Recognizing the Need for Medical Attention

Knowing when to seek medical attention is crucial for individuals with MS or those experiencing symptoms that may be indicative of the condition. While some symptoms may resolve on their own, others require prompt medical evaluation.

New or Worsening Symptoms

If you experience new neurological symptoms or a significant worsening of existing symptoms, it’s important to consult your healthcare provider. This includes:

• Sudden vision changes or loss
• New or increased weakness or numbness
• Severe balance problems or falls
• Significant cognitive changes

Potential MS Relapse

A relapse, also known as an exacerbation or flare-up, is characterized by new or worsening symptoms that last for at least 24 hours. Signs of a potential relapse include:

• Sudden onset of new symptoms
• Significant worsening of existing symptoms
• Symptoms that persist for more than a day

Early intervention during a relapse can help minimize its impact and prevent long-term complications.

Medication Side Effects

If you experience severe side effects from your MS medications or notice that your current treatment is not effectively managing your symptoms, it’s important to consult your healthcare provider. They may need to adjust your treatment plan or explore alternative options.

Regular Check-ups

Even if you’re not experiencing new or worsening symptoms, it’s important to maintain regular check-ups with your neurologist or MS specialist. These appointments allow for:

• Monitoring disease progression
• Assessing treatment effectiveness
• Addressing any concerns or questions
• Updating your care plan as needed

Remember, early detection and intervention can significantly impact the course of MS and improve long-term outcomes. Don’t hesitate to reach out to your healthcare provider if you have any concerns about your symptoms or overall health.

Living with MS: Strategies for Maintaining Quality of Life

Living with Multiple Sclerosis presents unique challenges, but with the right strategies and support, individuals can maintain a high quality of life. Here are some key approaches to consider:

Building a Support Network

A strong support network is invaluable for individuals living with MS. This can include:

• Family and friends
• MS support groups (both in-person and online)
• Mental health professionals
• MS organizations and advocacy groups

Connecting with others who understand the challenges of MS can provide emotional support, practical advice, and a sense of community.

Adapting Your Environment

Making adaptations to your home and workplace can help maintain independence and manage MS symptoms. Consider:

• Installing grab bars and handrails
• Using assistive devices for mobility
• Modifying your workspace for ergonomic comfort
• Implementing energy-saving strategies in your daily routine

Maintaining Physical and Mental Wellness

Prioritizing overall wellness can help manage MS symptoms and improve quality of life. This includes:

• Regular exercise tailored to your abilities
• Practicing stress-reduction techniques
• Maintaining a balanced, nutritious diet
• Engaging in cognitive exercises and activities
• Getting adequate rest and managing fatigue

Planning for the Future

While MS is unpredictable, planning for the future can provide a sense of control and peace of mind. Consider:

• Discussing long-term care options with your family
• Exploring financial planning and insurance options
• Creating advance directives for healthcare decisions
• Staying informed about MS research and treatment advancements

By taking a proactive approach to managing MS and focusing on overall well-being, individuals can lead fulfilling lives despite the challenges of the condition. Remember that every person’s experience with MS is unique, and it’s important to work closely with your healthcare team to develop a personalized management plan that addresses your specific needs and goals.

Multiple Sclerosis (MS) Symptoms and Early Warning Signs of MS

Written by WebMD Editorial Contributors

Medically Reviewed by Jabeen Begum, MD on February 20, 2023

• What Does MS Feels Like?
• Early Signs of MS
• Primary MS Symptoms
• Secondary Symptoms
• Tertiary Symptoms
• When to See Your Doctor 
• More

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then they come back. Some come and go, while others linger.

No two people have exactly the same symptoms. You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms get worse within weeks or months.

Keep track of what’s happening to you. It’ll help your doctor monitor your disease and help them understand how well your treatment works.

A lack of feeling or a pins-and-needles sensation can be the first sign of nerve damage from MS. It usually happens in your face, arms, or legs, and on one side of your body. It tends to go away on its own.

Numbness and tingling can also come from a lack of blood flow or a pinched nerve, so think first if you slept in a funny position or sat without moving for a long time. Other conditions can also lead to nerve damage: Carpal tunnel syndrome affects your wrist, while diabetic neuropathy can trigger numbness, tingling, or pain in your feet or hands.

Sudden numbness on one side of your body may signal a stroke. If that happens to you, call 911 ASAP. Learn more about causes of numbness and tingling in your limbs.

For many people, the first brush with what’s later diagnosed as MS is what doctors call clinically isolated syndrome (CIS). This episode of neurological symptoms usually lasts 24 hours. It happens when your immune system mistakenly tells your body to attack myelin, the protective sheath over nerve cells in your brain and spine. You may hear your doctor call this demyelination. It causes scars, or lesions, that make it harder for signals to travel between your brain and your body.

There are two types of CIS:

• Monofocal episode: You have one symptom.
• Multifocal episode: You have more than one symptom.

The most common symptoms in CIS are:

Optic neuritis: This condition damages the nerve that connects your eye to your brain. It usually affects just one eye, but in rare cases, it involves both. You might notice:

• Blurry vision
• Colors appear dull
• Pain in your eye, especially when you move it

Numbness and tingling: It usually affects your legs. You might feel:

• An electric shock-like feeling when you move your head or neck. It may travel down your spine or into your arms or legs.
• Numbness, often in your face
• Tingling

Not everyone who has CIS will get MS. The odds are higher if you have lesions in your brain from loss of myelin. If you have another CIS or other MS symptoms later, your doctor will do a test called an MRI that takes a picture of your brain to look for them. Learn more about the differences between CIS and MS.

See More: A Visual Guide to Multiple Sclerosis

These come from ongoing damage to your myelin. They aren’t pleasant, but your MS treatment team can help you keep most of them under control with medication, rehabilitation, and other tactics. The most common symptoms are:

Bladder and bowel problems: You may have to pee more often, need to go at night, or have trouble emptying your bladder fully. Bowel issues like constipation are also common. Read more on bladder control problems and bowel problems with MS.

Clumsiness or lack of coordination: MS can make it hard to get around. You might have:

• Trouble walking
• A hard time keeping your balance
• Changes in your gait

Dizziness: You may feel lightheaded. You probably won’t have vertigo, that feeling that the room is spinning. Know the causes of dizziness and vertigo with MS.

If you’re dizzy and nauseous when you’re lying down, or if you stumble to one side, it could be a problem with your inner ear, which controls your balance. Medications, such as those for depression and seizure disorders, can cause similar problems too. If the dizziness or stumbling are sudden or new, go to the emergency department at your local hospital to be checked out. It could be a stroke.

Did a quick wave of lightheadedness hit? That’s often a sign of low blood sugar, dehydration, or a sudden drop in blood pressure you get when you stand up quickly. You may need to slowly rise instead of hopping to your feet. 

Emotional changes and depression: It’s tough to adjust to the idea that you have a chronic disease, let alone one that’s hard to predict and that will take a physical toll. Fear of the unknown can make you anxious. Plus the disease damages nerve fibers in your brain, and that can affect your emotions. So can medications, like corticosteroids, used to treat MS. Get more information on how to manage depression with MS.

Eye problems: In addition to the optic neuritis that comes with CIS, MS can cause:

• Nystagmus: involuntary eye movements
• Diplopia: double vision

Learn more about vision problems linked to MS.

Fatigue: You may feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It isn’t usually related to the amount of work you do. Some people with MS say they can feel tired even after a good night’s sleep. Get tips on how to manage fatigue with MS.

Heat-related problems: You might notice them as you warm up during exercise. You could feel tired and weak or have trouble controlling certain body parts, like your foot or leg. As you rest and cool down, these symptoms are likely to go away. Know more on how to manage heat sensitivity with MS.

Muscle spasms: They usually affect your leg muscles. They’re an early symptom for almost half the people with MS. They also affect people with progressive MS. You might feel mild stiffness or strong, painful spasms. Read more on how to treat MS-related muscle spasms.

Sexual troubles: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm. Learn more on how to maintain intimacy when you have MS.

Speech problems: MS could cause long pauses between your words and slurred or nasal speech. You might have swallowing problems as the disease advances. Get more information on symptoms of speech and swallowing problems with MS.

Thinking problems: It might be hard to focus from time to time. This will probably mean slowed thinking, poor attention, or fuzzy memory. Some people have severe problems that make it hard to do daily tasks, but that’s rare. MS doesn’t usually change your intellect or ability to read and understand conversation. Find out more on how MS affects the brain and cognition.

Tremors: About half of people with MS have them. They can be minor shakes or so intense it’s hard to do everyday activities. Read more about the types of tremors caused by MS.

Trouble walking: MS can cause muscle weakness or spasms, which make it tough to walk. Balance problems, numb feet, and fatigue can also happen. Learn more about mobility aids and assistive devices for MS.

Unusual sensations: In addition to the pins and needles sensation that’s part of MS, you might also have severe itching, burning, stabbing, or tearing pains. You could feel a tightness around your ribs or upper belly known as the MS hug. Doctors call these uncomfortable symptoms dysesthesia. View a slideshow on unusual symptoms and sensations caused by MS.

These are problems created by your primary MS symptoms, not by damaged myelin.

• Not being able to empty your bladder can lead to a bladder infection.
• If you have trouble walking and are often fatigued, you’re likely to become less active. That can take a toll on your muscle tone, make your breathing shallow, and even affect your bone density.

Doctors can treat secondary symptoms, but the goal is to avoid them by treating the primary symptoms.

These are the social, psychological, and job-related problems of life with MS.

• If MS makes it hard for you to walk or drive, you may not be able to do your job well.
• Because it’s tough to get around and hard to talk to people about what life with a chronic disease is like, you may not be as social as you once were.
• You could get depressed. It’s a byproduct of the changes MS makes in your brain and in your life.

Because MS varies so much, it’s best not to compare yourself with other people who have it. Your experience is likely to be different. Most people learn to manage their symptoms and can keep leading full, active lives.

If you have sudden numbness on one side of your body or trouble seeing or speaking, get medical help right away. These may be signs of a life-threatening stroke.

If other symptoms associated with MS are out of the ordinary for you and last for more than a day, make an appointment to see your doctor. They can talk to you about what you’re feeling and do some tests to see if your issues are because of MS or another health problem.

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Multiple Sclerosis (MS) Symptoms and Early Warning Signs of MS

Written by WebMD Editorial Contributors

Medically Reviewed by Jabeen Begum, MD on February 20, 2023

• What Does MS Feels Like?
• Early Signs of MS
• Primary MS Symptoms
• Secondary Symptoms
• Tertiary Symptoms
• When to See Your Doctor 
• More

People with multiple sclerosis (MS) tend to have their first symptoms between the ages of 20 and 40. Usually the symptoms get better, but then they come back. Some come and go, while others linger.

No two people have exactly the same symptoms. You may have a single symptom, and then go months or years without any others. A problem can also happen just one time, go away, and never return. For some people, the symptoms get worse within weeks or months.

Keep track of what’s happening to you. It’ll help your doctor monitor your disease and help them understand how well your treatment works.

A lack of feeling or a pins-and-needles sensation can be the first sign of nerve damage from MS. It usually happens in your face, arms, or legs, and on one side of your body. It tends to go away on its own.

Numbness and tingling can also come from a lack of blood flow or a pinched nerve, so think first if you slept in a funny position or sat without moving for a long time. Other conditions can also lead to nerve damage: Carpal tunnel syndrome affects your wrist, while diabetic neuropathy can trigger numbness, tingling, or pain in your feet or hands.

Sudden numbness on one side of your body may signal a stroke. If that happens to you, call 911 ASAP. Learn more about causes of numbness and tingling in your limbs.

For many people, the first brush with what’s later diagnosed as MS is what doctors call clinically isolated syndrome (CIS). This episode of neurological symptoms usually lasts 24 hours. It happens when your immune system mistakenly tells your body to attack myelin, the protective sheath over nerve cells in your brain and spine. You may hear your doctor call this demyelination. It causes scars, or lesions, that make it harder for signals to travel between your brain and your body.

There are two types of CIS:

• Monofocal episode: You have one symptom.
• Multifocal episode: You have more than one symptom.

The most common symptoms in CIS are:

Optic neuritis: This condition damages the nerve that connects your eye to your brain. It usually affects just one eye, but in rare cases, it involves both. You might notice:

• Blurry vision
• Colors appear dull
• Pain in your eye, especially when you move it

Numbness and tingling: It usually affects your legs. You might feel:

• An electric shock-like feeling when you move your head or neck. It may travel down your spine or into your arms or legs.
• Numbness, often in your face
• Tingling

Not everyone who has CIS will get MS. The odds are higher if you have lesions in your brain from loss of myelin. If you have another CIS or other MS symptoms later, your doctor will do a test called an MRI that takes a picture of your brain to look for them. Learn more about the differences between CIS and MS.

See More: A Visual Guide to Multiple Sclerosis

These come from ongoing damage to your myelin. They aren’t pleasant, but your MS treatment team can help you keep most of them under control with medication, rehabilitation, and other tactics. The most common symptoms are:

Bladder and bowel problems: You may have to pee more often, need to go at night, or have trouble emptying your bladder fully. Bowel issues like constipation are also common. Read more on bladder control problems and bowel problems with MS.

Clumsiness or lack of coordination: MS can make it hard to get around. You might have:

• Trouble walking
• A hard time keeping your balance
• Changes in your gait

Dizziness: You may feel lightheaded. You probably won’t have vertigo, that feeling that the room is spinning. Know the causes of dizziness and vertigo with MS.

If you’re dizzy and nauseous when you’re lying down, or if you stumble to one side, it could be a problem with your inner ear, which controls your balance. Medications, such as those for depression and seizure disorders, can cause similar problems too. If the dizziness or stumbling are sudden or new, go to the emergency department at your local hospital to be checked out. It could be a stroke.

Did a quick wave of lightheadedness hit? That’s often a sign of low blood sugar, dehydration, or a sudden drop in blood pressure you get when you stand up quickly. You may need to slowly rise instead of hopping to your feet. 

Emotional changes and depression: It’s tough to adjust to the idea that you have a chronic disease, let alone one that’s hard to predict and that will take a physical toll. Fear of the unknown can make you anxious. Plus the disease damages nerve fibers in your brain, and that can affect your emotions. So can medications, like corticosteroids, used to treat MS. Get more information on how to manage depression with MS.

Eye problems: In addition to the optic neuritis that comes with CIS, MS can cause:

• Nystagmus: involuntary eye movements
• Diplopia: double vision

Learn more about vision problems linked to MS.

Fatigue: You may feel very tired. It often comes on in the afternoon and causes weak muscles, slowed thinking, or sleepiness. It isn’t usually related to the amount of work you do. Some people with MS say they can feel tired even after a good night’s sleep. Get tips on how to manage fatigue with MS.

Heat-related problems: You might notice them as you warm up during exercise. You could feel tired and weak or have trouble controlling certain body parts, like your foot or leg. As you rest and cool down, these symptoms are likely to go away. Know more on how to manage heat sensitivity with MS.

Muscle spasms: They usually affect your leg muscles. They’re an early symptom for almost half the people with MS. They also affect people with progressive MS. You might feel mild stiffness or strong, painful spasms. Read more on how to treat MS-related muscle spasms.

Sexual troubles: These include vaginal dryness in women and erection problems in men. Both men and women may be less responsive to touch, have a lower sex drive, or have trouble reaching orgasm. Learn more on how to maintain intimacy when you have MS.

Speech problems: MS could cause long pauses between your words and slurred or nasal speech. You might have swallowing problems as the disease advances. Get more information on symptoms of speech and swallowing problems with MS.

Thinking problems: It might be hard to focus from time to time. This will probably mean slowed thinking, poor attention, or fuzzy memory. Some people have severe problems that make it hard to do daily tasks, but that’s rare. MS doesn’t usually change your intellect or ability to read and understand conversation. Find out more on how MS affects the brain and cognition.

Tremors: About half of people with MS have them. They can be minor shakes or so intense it’s hard to do everyday activities. Read more about the types of tremors caused by MS.

Trouble walking: MS can cause muscle weakness or spasms, which make it tough to walk. Balance problems, numb feet, and fatigue can also happen. Learn more about mobility aids and assistive devices for MS.

Unusual sensations: In addition to the pins and needles sensation that’s part of MS, you might also have severe itching, burning, stabbing, or tearing pains. You could feel a tightness around your ribs or upper belly known as the MS hug. Doctors call these uncomfortable symptoms dysesthesia. View a slideshow on unusual symptoms and sensations caused by MS.

These are problems created by your primary MS symptoms, not by damaged myelin.

• Not being able to empty your bladder can lead to a bladder infection.
• If you have trouble walking and are often fatigued, you’re likely to become less active. That can take a toll on your muscle tone, make your breathing shallow, and even affect your bone density.

Doctors can treat secondary symptoms, but the goal is to avoid them by treating the primary symptoms.

These are the social, psychological, and job-related problems of life with MS.

• If MS makes it hard for you to walk or drive, you may not be able to do your job well.
• Because it’s tough to get around and hard to talk to people about what life with a chronic disease is like, you may not be as social as you once were.
• You could get depressed. It’s a byproduct of the changes MS makes in your brain and in your life.

Because MS varies so much, it’s best not to compare yourself with other people who have it. Your experience is likely to be different. Most people learn to manage their symptoms and can keep leading full, active lives.

If you have sudden numbness on one side of your body or trouble seeing or speaking, get medical help right away. These may be signs of a life-threatening stroke.

If other symptoms associated with MS are out of the ordinary for you and last for more than a day, make an appointment to see your doctor. They can talk to you about what you’re feeling and do some tests to see if your issues are because of MS or another health problem.

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Multiple sclerosis: causes, initial symptoms

There are different opinions about what is considered the beginning of the disease. In the previous chapter, we reflected a combination of risk factors, indicated that the combination of genetic predisposition and environmental influences ultimately triggers processes in the body that eventually gain a “critical mass” and lead to the manifestation of the disease. You have probably heard such terms: radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), maybe someone has these phrases printed in their medical report. In this chapter, we will analyze in detail what it is and what to expect for a person with this diagnosis. Let us first say that isolated syndromes are changes in the body that are not sufficient for a final diagnosis. The doctor receives a certain set of data, but he cannot tell you exactly what will happen next. He will operate with probabilities: probably such-and-such a disease is such, and such-and-such and that’s it. Uncertainty will be less if the doctor knows what to do next, what examination methods to apply, but still it will remain until the doctor receives additional data during the time that are necessary and sufficient for making a diagnosis. And the period of observation can stretch for years.

Radiologically isolated syndrome

The term is quite complicated, it means the following: radiologically – this syndrome can only be detected using radiological diagnostic methods, namely MRI. To put it simply, the patient was usually bothered by headaches or decided to “check it out” on his own, went and performed an MRI of the brain, because you can prescribe it yourself without first contacting a doctor. I got pictures, looked at the conclusion, and there “bang!”: “single foci (or focus) were detected, taking into account the age of the patient, a demyelinating process cannot be ruled out.” The hand quickly reaches for the phone or computer mouse, the word “demyelinating” is entered into the search bar, start-up and that’s it, life has entered a gray streak, sleepless nights have come, anxiety, tears, a solid “nervous”. It was I who described the radiologically isolated syndrome (RIS) quite simply, so to speak, on the fingers. But in reality, everything is much more complicated. RIS may or may not be a precursor to multiple sclerosis. A significantly larger proportion (at least two-thirds) of patients with RIS remain with this RIS and do not develop multiple sclerosis. And foci on MRI can be due to congenital changes in the central nervous system, the consequences of trauma, hypoxia, and much more. A minority of patients with RIS eventually develop multiple sclerosis; in this case, RIS is a kind of predisease, when the body has already passed the point of no return, immunological disorders continue, which over time will result in a disease. Therefore, when your radiologist described the presence of foci, then in no case should you panic, rush about, cry, predict a quick end for yourself. No, you need to calm down, contact a neurologist, and best of all, a specialist in multiple sclerosis and undergo an examination. What will the survey show? It will confirm that the identified foci are harbingers of a demyelinating or other disease. But, there may be a situation when all the analyzes come back negative and do not indicate any disease: this is possible in a larger percentage of cases. Then you will be kept under observation.

Clinically isolated syndrome

Clinically isolated syndrome (CIS) is a step towards multiple sclerosis. As in the case of RIS In contrast to the radiologically isolated syndrome, 2/3 of patients with CIS will develop multiple sclerosis. On MRI, not just some single, as yet of unknown origin, foci appear, but foci already have signs characteristic of MS. But the most important thing is the presence of a clinical manifestation. What are clinical manifestations? These are symptoms, signs that are felt by the patient himself and are confirmed objectively when examined by a neurologist. These include numbness of the limbs or one limb, trunk, face, weakness of the limbs, impaired coordination, decreased vision in one eye (sometimes in both eyes at once), double vision. You may also experience fatigue, expressed against the background of the usual daily load, fatigue, inability to complete the work. On the other hand, such symptoms may appear, be confirmed by a specialist, but there are no foci on MRI. In this case, only 1/5 of patients will develop multiple sclerosis, the rest should be talking about another disease. What do we do in this case? It is very important at the stage of making a diagnosis of CIS to be sure that it is CIS, and not multiple sclerosis. Further treatment will depend on the correctness of the diagnosis. If with CIS we can still wait, observe patients (let me remind you that 1/3 of them will not develop multiple sclerosis), then when multiple sclerosis is confirmed, the doctor is simply obliged to prescribe treatment with drugs that change the course of MS. And the correctness of the distinction between CIS and MS entirely depends on the knowledge and skills of the doctor, how correctly he interviewed the patient, accurately assessed the clinical manifestations, assessed the changes on the MRI, did not miss anything. A lumbar puncture, additional blood tests, and sometimes genetic testing are often required. Let’s return to MRI: the number of foci in the white matter can be counted, but the diagnosis does not depend very much on their number. There are more subtle changes on an MRI that may be more likely to indicate future multiple sclerosis. We will discuss this in the chapter on the diagnosis of MS. So, to summarize: CIS is the next step after RIS to multiple sclerosis. The main thing in a clinically isolated syndrome is the presence of symptoms similar to those of MS. CIS can become multiple sclerosis in 2/3 cases. If you fall into these two-thirds, then in the future, when there is already a diagnosis of MS, the doctor-specialist in multiple sclerosis will talk about the current CIS as the debut of multiple sclerosis.

We have discussed what radiologically and clinically isolated syndromes are. One goes into the other: first there is RIS, then CIS. Changes in the body at the level of the immune system occur before the syndromes. And before immunological changes, risk factors should form like fragments into a single mosaic. Internal factors (not changeable) – genetically determined features of the combination of genes, gender of a person, his place of birth – are combined with external (potentially changeable) – latitude of residence (effect in childhood), infectious mononucleosis (effect in adolescence), vitamin D deficiency, smoking. To these we must add factors unknown to us. Also, we do not know whether a combination of all factors or only a part is necessary, because apart from the Epstein-Barr virus, which occurs in 100% of MS patients, other factors may or may not be present in our patients. (Fig. – scheme of the beginning of the development of MS). Most likely, the onset of multiple sclerosis is not a one-time event, but a process that develops over time, possibly from early childhood, in this process we single out several artificial stages: immunological disorders (endophenotype), radiologically isolated syndrome, clinically isolated syndrome. Such a conditional division is necessary for the doctor to decide on the need and scope of examinations, and planning therapy. In any case, if you see the word syndrome in your medical report, do not be afraid, do not despair, do not make hasty decisions, calm down and contact a multiple sclerosis specialist. Ask him questions, and do not look for answers only on the Internet.

Multiple sclerosis – treatment, symptoms, causes, diagnosis

Multiple sclerosis is a disease that affects the spinal cord and brain, resulting in loss of muscle control, visual disturbances, imbalance of the body, sensory disturbances (numbness). In multiple sclerosis, the nervous system is damaged by the body’s own immune system. That is, in fact, multiple sclerosis is considered an autoimmune disease. In autoimmune diseases, the immune system attacks its own organs and tissues (examples of autoimmune diseases are systemic lupus erythematosus and rheumatoid arthritis).

The central nervous system is made up of nerves that act as the body’s information system. Each nerve is covered in a fatty substance called myelin, which insulates the nerves and helps in the transmission of electrical impulses along the nerves, carrying information from the brain to the organs. These nerve impulses control muscle movements such as walking and talking.

Multiple sclerosis gets its name from an increase in scar tissue in the brain or spinal cord. Scar tissue or plaques form when the protective and insulating myelin that covers the nerves is destroyed, a process called demyelination. Without myelin, the electrical signals transmitted through the spinal cord and brain are interrupted or not transmitted. The brain then becomes unable to send and receive information. It is this communication breakdown that causes the symptoms of MS.

Although nerves can replicate myelin, this process is quite slow and has not kept up with the damage caused by demyelination. Symptoms and their severity depend on the location of the scar tissue and the degree of demyelination.

In the US, multiple sclerosis is one of the most common causes of neurological disability in middle-aged people.

MS is two to three times more common in women than men and is extremely rare before puberty. Most often, multiple sclerosis occurs between the ages of 20 and 40; as a rule, it does not occur at an older age.

Causes

The causes of multiple sclerosis are still unclear, but there is evidence that genetics, environment and even viruses can play a role.

Epidemiological data reveal several interesting trends in the incidence of multiple sclerosis: there is a different prevalence and a certain ethnic dependence of the disease of multiple sclerosis. The disease is more common in northern countries and in people of the white race.

Studies show that MS is more common in certain parts of the world, but if you move from a higher-risk area to a lower-risk area, the risks decrease if the move was before puberty.

In addition, MS is a disease of temperate climates. In both hemispheres, its prevalence increases with increasing distance from the equator.

There have also been “epidemics” of MS in history, for example, a group of people living off the coast of Denmark fell ill with multiple sclerosis after the Second World War, possibly due to some environmental problems.

Multiple sclerosis researchers believe that there are certain genetic prerequisites for the disease of multiple sclerosis.

Researchers believe that there is more than one gene that predisposes to the risk of developing multiple sclerosis. In addition, scientists believe that a person is born with a genetic readiness to develop this disease under certain environmental triggers. With the development of gene analysis, it may be possible to obtain more information about the role of genes.

Certain studies do not exclude the role of viruses, especially Epstein-Bar, herpes zoster, even hepatitis vaccines. But clear evidence of the involvement of viruses in the development of multiple sclerosis has not yet been received. The provoking factors in the development of multiple sclerosis also include sex hormones (estrogen and testosterone), which, if released in excess, can depress the immune system, especially estrogen (women get sick 2-3 times more often than men). But their role is also not clear. Currently, scientists have come to the conclusion that the disease occurs due to a number of factors.

Symptoms

Symptoms of multiple sclerosis appear more frequently between the ages of 20 and 40. Typically, a person notices symptoms after two or more distinct episodes of symptoms have developed before MS is suspected.

The most common early symptoms of MS include:

• Tingling
• Numbness
• Body imbalance
• Weakness in one or more limbs
• Visual impairment or diplopia
• Other symptoms are much less common:
• Slurred speech
• Sudden onset of paralysis
• Impaired coordination of movements
• Cognitive impairment

As the disease progresses, symptoms such as spasticity, sensitivity to heat, fatigue, changes in thinking or perception, and sexual dysfunction appear.

• Fatigue. This is a characteristic and common symptom of MS. It usually appears in the afternoon and can present with severe muscle weakness, mental fatigue, sleepiness. Feeling physically exhausted is not related to the amount of work done and many MS patients complain of extreme fatigue even after getting enough sleep.
• Sensitivity to high temperature. Heat sensitivity: The onset or worsening of symptoms after being exposed to heat (eg, after taking a shower) occurs in most MS patients.
• Muscle spasticity. Muscle spasticity is a common and often debilitating symptom of MS. Muscle spasticity usually affects the muscles of the legs and arms, and can affect the motor abilities of the limbs.
• Dizziness. Many patients with multiple sclerosis experience a feeling of dizziness. The occurrence of this symptom is associated with a violation in the transmission of nerve impulses in a complex system that ensures the balance of the body (vision, proprioception, etc. )
• Cognitive impairment. Problems with thought processes occur in approximately half of MS patients. There is a violation of concentration, memory impairment. In 10% of patients, severe cognitive impairment occurs and they lose the ability to serve themselves.
• Visual impairment. Vision problems are quite common in MS patients. Visual impairment is mainly associated with optic neuritis and occurs in 55% of cases. As a rule, visual impairment rarely leads to complete blindness.
• Pathological sensations. Many patients experience various pathological sensations such as tingling with pins, itching, and point pain. As a rule, these symptoms are not life-threatening and are quite well removed by treatment.
• Speech and swallowing disorders. Some patients have problems with both swallowing and speech. This is due to damage to the nerves responsible for these functions.
• Tremor. This symptom is quite common in patients with multiple sclerosis and, unfortunately, is difficult to treat.
• Violation of walking. Gait disturbance is a fairly common symptom in multiple sclerosis. This is mainly due to muscle weakness or muscle spasticity. In addition, the cause may be a violation of coordination of movements and balance of the body.

Rare symptoms of multiple sclerosis include breathing problems and seizures.

Symptoms are divided into three categories: major, secondary, and tertiary.

The main symptoms are a direct result of the demyelination process. Demyelination impairs the transmission of electrical signals to the muscles (to allow the muscles to move) and to the organs of the body (to allow them to perform their normal functions.) Symptoms include: weakness, tremors, tingling, numbness, imbalance, blurred vision, paralysis, and problems with function bladder or intestines. Modern methods of treatment allow you to control these symptoms.

Secondary symptoms are a consequence of the main symptoms. For example, paralysis (the main symptom) can lead to pressure sores, and bladder dysfunction can cause frequent, recurrent urinary tract infections. These symptoms are also treatable, but the main task is to prevent the occurrence of complications.

Tertiary symptoms – social, psychological, and vocational symptoms arising from the patient’s disability and disability in varying degrees. Depression, for example, is quite common in patients with multiple sclerosis.

Unfortunately, the symptoms of each patient manifest themselves in a peculiar way, as well as the progression of the disease. Some patients may have mild symptoms for years without progression. In other cases, the disease can progress rapidly over several months. And with a variety of symptoms, some may have some symptoms and not have others.

Diagnosis

Unfortunately, there is no specific analysis or instrumental research method that can make a 100% diagnosis of multiple sclerosis. However, there are generally accepted criteria for making a diagnosis, but even this system of criteria is not perfect.

The initial diagnosis of MS can be difficult. In almost 10% of cases, under the guise of multiple sclerosis, other diseases occur, such as vascular inflammation, multiple strokes, SLE brain infections, and even hypo- or beriberi. Sometimes even stress-related functional impairment can lead to a misdiagnosis of MS.

Multiple sclerosis develops in different ways and its course is sometimes unpredictable. In many patients, the disease begins with a single symptom that persists for months or even years without any progression of the symptoms. In other cases, symptoms worsen over weeks or months.

It is important to understand that with all the variety of symptoms, each individual patient may have only a few symptoms and never have others. Some symptoms may occur once and never appear again.

MRI is the best way to visualize changes caused by multiple sclerosis. The accurate image produced by MRI provides strong evidence of scar tissue in the deep structures of the brain and spinal cord that is characteristic of multiple sclerosis

However, MRI lesions can also be caused by other conditions (eg, similar changes are observed in elderly people with cerebral atherosclerosis). Therefore, MRI data must be compared with clinical data and neurological status.

In addition, a normal MRI does not absolutely exclude the diagnosis of MS. Approximately 5% of patients with clinical manifestations of multiple sclerosis may not have morphological changes visually confirmed by MRI. This is especially possible when conducting studies on MRI devices with low resolution (low-field MRI).

Spinal puncture is sometimes used to diagnose multiple sclerosis, but to a greater extent it is necessary when it is necessary to exclude other diseases of the central nervous system (tumors of infection) and analysis of the punctate allows to verify the diagnosis. For the diagnosis of multiple sclerosis itself, the puncture is not of great diagnostic value.

Neurophysiological studies using evoked potentials help detect impaired function of the nerves that provide hearing, sensitivity and pathways.

Laboratory blood tests are prescribed for the differential diagnosis of other diseases with similar symptoms and are necessary to rule out a diagnostic error.

Prognosis

After any patient is diagnosed, a natural question arises about life expectancy. Unfortunately, it is sometimes not possible to unambiguously predict what the course of a disease will be in a particular person, even if a full-fledged treatment is carried out. Prognostic chances increase with early diagnosis and slow progression of the disease. The maximum life expectancy is very variable and ranges from 7 years or more.

Treatment

New drugs that have recently appeared have significantly improved the prognosis of this devastating disease.

Even though the long-term prognosis of these drugs is not yet fully understood, some of the risks are accepted by patients in exchange for sustained remission and less disability in the near future. This is one of the reasons why physicians have recently changed the criteria based on which they diagnose multiple sclerosis.

In the past, physicians typically waited for the second clinical manifestation of a particular set of symptoms or an attack of MS before actually diagnosing the disease and starting therapy. But as a result of recent research, they have made some changes. Two medical criteria are used to diagnose multiple sclerosis:

• Clinically isolated syndrome. This is a complex of physical symptoms associated with multiple sclerosis, lasting at least 24 hours. It can be as significant as Williamson’s palsy, or it could be more minor, like permanent numbness in one arm or leg, or sudden loss of vision in one eye (optic neuritis).
• Signs of damage in the brain. Lesions in MS are usually detected using magnetic resonance imaging. These lesions are caused when inflammation leads to the loss of myelin, a protective substance that insulates nerves in the brain and spinal cord.

A single clinically isolated syndrome is now sufficient to diagnose MS if clinicians see characteristic changes on MRI.

Currently, a whole group of drugs has appeared, which will appear in medical institutions in 2012. But today there are eight drugs, the effectiveness of which has been proven by numerous clinical studies.

• Avonex (interferon beta-1a) Betaseron (interferon beta-1b)
• Copaxone (glatiramer acetate)
• Extavia (interferon beta-1b)
• Gilenia(fingolimod, FTY720)
• Novantrone (mitoxantrone)
• (interferon beta-1a)
• Tysabri (natalizumab)

What drugs are preferable for treatment? Unfortunately, opinions about first-line drugs are divided and, at present, each patient is prescribed a drug from this group, taking into account side effects and the clinical picture. Moreover, the drugs act on different patients in different ways. Therefore, an unambiguous approach to treatment has not yet been developed and sometimes it is necessary to select a treatment for the patient, although the cost of some drugs manufactured using genetic engineering is very high.

In addition to these drugs, steroids are used in the treatment of multiple sclerosis, which help to significantly reduce neurological deficits (recently, pulse therapy with steroid doses is preferred).