Symptoms of Multiple Sclerosis

Symptoms of multiple sclerosis depend on the location of specific lesions.

1. Sensory Symptoms

• Hypoesthesia: a decreased sense of touch or sensation.
• Numbness of face, body, or extremities
• Paresthesia: means altered sensation

2. Pain

• 55% of patients with multiple sclerosis experience pain clinically.
• Patient's experience acute, paroxysmal pain characterized by sudden and spontaneous onset.
• Pains are described as intense, sharp, shooting, electric shock-like, and burning.
• Common types of pain:
• Paroxysmal limb pain
• Headache
• Optic or trigeminal neuritis
• Lhermitte's sign: In patients with posterior column damage, flexion of the neck produces electric shock-like sensation running down the spine to lower extremities.
• Hyperpathia: hypersensitivity to minor sensory stimuli.
• Chronic neuropathic pain: result from the demyelinating lesion in spinothalamic tracts or in the sensory roots.

3. Visual Symptoms

• Optic neuritis: inflammation of the optic nerve that produces an ice pick-like pain behind the eye with blurring or greying of vision or blindness in one eye.
• Scotoma: dark spot maybe occurs in the centre of the visual field.
• Nystagmus: 
• The involuntary cyclical movement of the eyeball (horizontal or vertical) that develop when the patient looks to the sides or vertically (gaze-induced nystagmus) or when the patient moves the head.
• A result from lesions affecting the cerebellum or central vestibular pathways. 
• Lateral gaze palsy: 
• Internuclear ophthalmoplegia produces incomplete eye adduction (lateral gaze palsy) on the affected side and nystagmus of the opposite abducting eye with gaze to one side.
• It is caused by demyelination of the medial longitudinal fasciculus.
• Diplopia 

4. Motor Symptoms

Patients with corticospinal lesions demonstrate signs and symptoms of upper motor neuron syndrome such as;

• Paresis or weakness of muscle 
• Spasticity
• Brisk tendon reflexes
• Involuntary flexor and extensor spasm
• Clonus
• Positive Babinski's sign 
• Exaggerated cutaneous reflexes
• Loss of autonomic control

Fig.1: Areas affected by multiple sclerosis

5. Fatigue:

A subjective lake of physical and mental energy that is perceived by the individual to interfere with usual and desired activities.

6. Coordination and balance

A demyelinating lesion in the cerebellum and cerebellar tracts producers cerebellar symptoms such as:

• Ataxia: uncoordinated movements.
• Postural tremor
• Intention (action) tremor: involuntary, rhythmic, shaking movements occur when purposeful movement is attempted.
• Hypotonia
• Truncal weakness
• Impaired gait

7. Speech and Swallowing

• Dysarthria: slurred or poorly articulated speech with low volume, unnatural emphasis, and slow rate.
• Dysphonia: change in vocal quality including harshness, hoarseness, breathiness, or hypernasal sounds.
• Dysphagia: poor coordination of the tongue oral muscles can result in difficulty in swallowing.

8. Short-term memory loss

9. Depression

10. Anxiety

11. Emotional

• Pseudobulbar affect: 
• also known as Involuntary emotional expression disorder/Emotional incontinence.
• It is characterized by sudden and unpredictable episodes of crying, laughing, or other emotional display.
• Euphoria consists of an exaggerated feeling of well being.
• Bipolar affective disorder

12. Bladder and Bowel Symptoms

• Demyelinating lesions affect the lateral and posterior spinal tracts unmasked the sacral reflex arc producing a loss in volitional and synergistic control of the micturition reflex.
• Type of bladder dysfunction in MS
• Flaccid bladder
• Spastic bladder
• Dyssynergic bladder: problem with coordination between the bladder contraction and sphincter relaxation.
• Constipation is the most common bowel complaints in MS and results from legends affecting control of gastrocolic reflex.

13. Sexual Dysfunction

• Sexual dysfunction affects 91% of men and 72% of women.
• In women, symptoms can include:
• Changes in sensation
• Vaginal dryness
• Trouble reaching orgasm
• Loss of libido (sexual desire).
• In men, symptoms can include:
• Importance
• Decreased sensation
• Difficulty or inability to ejaculate
• Loss of libido.

 

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