Multiple sclerosis presents differently in each individual since it is characterized by damage and inflammation of the myelin sheath. Clinical manifestations are extremely diverse and variable as the symptoms depend on the location of the lesion and extent of tissue destruction. The symptoms may also differ over the course of the disease as they improve during periods of remission for some specific patients. They include the involvement of motor, sensory, visual and autonomic systems in most MS patients (Mayo Clinic, 2016; Multiple Sclerosis Society of Canada, 2016; Tullman, 2014).
Common Presentations
Fatigue
One of the most debilitating symptoms in MS and occurs in around 80% of patients. Individuals typically describe fatigue as general sense of low energy (Gelfand, 2014).
Weakness
This symptom affects up to 89% of MS patients at some point in the disease course and is due to corticospinal tract lesions. Weakness is often described as a sensation of heaviness in the limbs and is more commonly affected in legs than arms. Unilateral symptom presentation is also more common than bilateral presentation (Gelfand, 2014).
Headache and Pain
Two-third of MS patients complain of headaches. Most of the headaches are attributed to migraines. Pain is another common symptom which is present in around 50% of MS patients. It is typically described as burning, electrical or sharp sensations (Gelfand, 2014).
UHthoff phenomenon
This phenomenon is the temporary worsening of signs and symptoms when core body temperature increases like during a hot bath or intense exercise. Demyelinated fibers are sensitive to small increases of core temperature which results in delays of conduction. Heat aggravates MS symptoms and can also bring out old symptoms. (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).
VertiGo
Impaired balance and dizziness are common in MS and can be caused by brainstem lesions. These symptoms may be permanent or they could be relapse symptoms (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).
Optic Neuritis
This is an inflammation of the optic nerve. It is a presenting symptom in about 20% of MS patients and affects about half of MS patients at some point in the course of the disease. Typically, it presents as a sudden onset of blurry vision or loss of vision in one eye and is associated with pain during eye movement. Loss of acuity, presence of relative afferent pupillary defect (both pupils dilate when bright light is swung from unaffected eye to affected eye), colour desaturation and a central scotoma are also common manifestations of optic neuritis (Blazek, 2012; Gelfand, 2014; Miller & Deangelis, 2014).
Cognitive Impairment
Subtle cognitive deficits affect up to 40-70% of MS patients. It can be one of the earliest symptoms of MS. Most common domains affected are formal processing, executive dysfunction and impairment of short-term verbal and visual memory (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).is Society of Canada, 2016).
Depression
Major depression affects about 30-45% of MS patients at some point during their disease. It is more common in people with MS than in the general population (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).
Sensory Impairment
The most common sensory symptom is numbness which may present in one or more limbs that usually occurs on one side of the body at a time. There is typically an unusual sensation in a portion of a limb when individuals wake up in the morning. This sensation may gradually increase in intensity and travel towards the body trunk (Mayo Clinic, 2016; Multiple Sclerosis Society of Canada, 2016).
Lhermitte's sign
It occurs in one third of MS patients at some point in the disease. This symptom is an electrical sensation going down the spine and can occasionally radiate towards the limbs. Typically, it is triggered when the neck is bent forward. (Gelfand, 2014).
Spasticity
This presenting symptom is an increase in resistance to passive muscle stretch. It is associated with stiffness, tremors, cramping and gait impairment (Multiple Sclerosis Society of Canada, 2016).
Dysphagia and Dysarthria
These symptoms are caused by brainstem lesions. Dysarthria is difficulty speaking and speech can sound unclear and distorted. This symptom is often associated with difficulty chewing and swallowing due to weakness and spasticity of the muscles of lips, tongue, soft palate and vocal cords (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).
Gait Ataxia and Incoordination
These symptoms are presented in approximately 13% of MS patients and can be caused by cerebellar lesions. Several factors may contribute to difficulty in walking such as muscle weakness, tremors, spasticity, loss of balance, fatigue and pain (Gelfand, 2014; Multiple Sclerosis Society of Canada, 2016).
Detrusor Hyperreflexia
About two-third of MS patients are affected with these symptoms. This is basically an overactive bladder. Urinary urgency, frequency and incontinence are common symptoms (Gelfand, 2014).
Bladder Underactivity
Symptom of incomplete emptying is present in about 20-25% of MS patients with bladder symptoms (Gelfand, 2014).
Constipation
Constipation is less common than bladder dysfunction but is still a common complaint from MS patients (Gelfand, 2014).
Sexual Dysfunction
It is reported to affect up to around one-third of patients. Erectile dysfunction is most common in men whereas loss of libido is most common in women (Gelfand, 2014).
Paroxysmal Tonic Seizures
Tonic seizures are involuntary contractions of the limbs. They are confined to one side of body and lasts about 30 seconds to a minute and can occur approximately greater than 15 times a day (Gelfand, 2014).