Early signs of MS

What is multiple sclerosis?

Multiple sclerosis, otherwise known as MS, is a central nervous system (CNS) disease that makes the immune system attack the protective coating of nerves in the brain and spinal cord.¹ At the cellular level, an inflammatory immune response destroys myelin sheathing (demyelination), which surrounds and protects healthy nerves.² Demyelination causes signal disruptions in communications to and from the brain. MS is unpredictable and inconsistent; it manifests differently in each person.

The four types of MS

1. Relapsing-remitting. About 90% of people with MS are first diagnosed with relapsing-remitting MS, named for the pattern of relapse (active symptoms) followed by a period of remission (absence of symptoms). The length of remission varies by individual. Remission windows can be short (weeks or months) or long (years), and certain treatments may extend the length of a remission. Without treatment, most symptoms do worsen with time.
2. Secondary progressive. When you’re symptomatic all the time and are no longer having periods of remission, just times where symptoms are stable, MS has reached a phase called secondary progressive. Symptoms will persist and likely worsen, and may begin to affect day-to-day functional abilities.
3. Primary progressive. 10 to 15% of MS cases are primary progressive, which means the disease progresses consistently, ultimately resulting in a gradual decline in mobility. People with primary progressive MS almost never experience relapses. When they do, it’s referred to as progressive-relapsing MS.
4. Benign. The rarest type of MS is benign, accounting for about 5 to 10% of all MS cases. MS can be classified as benign if the disease has a mild presentation and has not worsened or measurably progressed for about 15 years.

Variability in MS symptoms is huge. The disease is unpredictable and affects everyone differently when it comes to things like symptom duration, intensity, frequency, and severity. However, there are several commonly reported signs and symptoms of MS.

Common early signs and symptoms of MS include:

• Vision problems. A sudden change in your vision (things like blurriness, poor ability to distinguish or contrast color, double vision, pain whenever your eyes move) can be a first sign of MS. The optic nerve is part of the central nervous system, and if MS is attacking the myelin sheath around it, it becomes inflamed. This inflammation is called optic neuritis. MS can also cause nystagmus, a condition where your eyes “beat” rapidly and involuntarily in one direction. This can cause vertigo (the sensation that the world is moving or spinning in an unsteady way). Diplopia, otherwise known as double vision, can occur when the nerves responsible for eye movement are damaged.
• Numbness or tingling. Tingling on the face, body, arms, and legs is the earliest symptom of MS for some people.
• MS hug. An MS hug (dysesthesia) is a squeezing or deep pressure sensation around the torso, similar to the way a blood pressure cuff feels when tightened all the way around your bicep. This symptom can signal a relapse or can be an early symptom of MS.

Other common symptoms of MS include:

• Fatigue
• Muscle weakness and spasms
• Dizziness (or, infrequently, vertigo)
• Incontinence
• Imbalance and unsteadiness
• Chronic pain
• Itching
• Sexual dysfunction
• Emotional and cognitive changes

How is MS diagnosed?

There isn’t a single test or criteria that can definitively diagnose MS. Instead, diagnosing MS can be a process of rule outs, tests, and thorough neurological exams. An official diagnosis of MS is made according to a 3-factor test, and all elements must be met:

1. All other possible explanations and diagnoses have been ruled out;
2. There is evidence of demyelination in at least two distinct areas of the CNS, which is comprised of the spinal cord, brain, and optic nerves; and
3. There is evidence that the observed damage occurred at different points in time.

Neurological exams. A medical history and a neurological exam are sometimes sufficient to make a confident guess at an MS diagnosis, but extensive rule outs, medical imaging scans, and the passing of time are often needed to definitively confirm it. A neurological exam tests key functions often affected by MS, such as reflexes, coordination, balance, sensory perception, and cranial nerve function (ability to swallow, see, hear, control facial muscles, and feel facial sensations).

Medical imaging scans. MRIs of the brain and/or spine are helpful in spotting areas of demyelination, sometimes referred to as lesions or plaques. In spots along the brain and spinal cord where the myelin is stripped, electrical signals that would normally pass smoothly between brain and body become fuzzy and choppy, causing unpleasant and sometimes painful symptoms.³ Getting an MRI with contrast allows radiologists to clearly identify existing and new lesions.

Rule outs. Blood tests can rule out diseases that have similar symptoms to MS, like infections, hereditary diseases, mineral or vitamin deficiencies, and other immune system disorders like lupus and Sjogren’s syndrome.

Other tests. Cerebrospinal fluid evaluations via spinal tap or lumbar puncture can confirm the presence of immune function abnormalities. Evoked potential studies use various sensory nerve stimulations to measure the speed and quality of electrical conduction along nerve pathways.

Risk factors for MS

Though basic causes of MS have not been conclusively established, there are certain factors that seem to increase the risk of developing it. Women are three times as likely as men to develop MS. MS also behaves differently during and after pregnancy. Both of these things suggest that female hormones may play a role in its development. Stress, smoking, age (most diagnoses are made between ages 20 to 50), low vitamin D, and obesity have also been linked to higher rates of MS.

How is MS treated?

There's no cure for MS yet, but early detection is crucial to managing symptoms and slowing its progress. Once MS has been diagnosed, there are a number of ways to manage it:

• Many medications can reduce relapses, delay symptom and disability progression, treat relapses, and limit further demyelination. These medications can be taken orally, injected, or infused.
• Maintaining your ability to function is a big part of MS treatment. Physical, occupational, vocational, and cognitive rehabilitation can help you preserve your quality of life.
• Neuropsychologists are useful in supporting your mental and emotional health.
• Follow-up MRIs at regular intervals (every 6 to 12 months, or more often if needed) can help radiologists track new or changing lesions in your CNS.

Schedule your scan

If you've been diagnosed with MS or are being screened for it and need an MRI, head to scan.com’s scan search tool and find a reputable scan center near you.

Resources: 

1. nationalmssociety.org: National MS Society

2. hopkinsmedicine.org: What is Multiple Sclerosis (MS)?

3. clevelandclinic.org: Multiple Sclerosis (MS): Symptoms, Diagnosis & Treatments