The symptoms of multiple sclerosis vary greatly from one person to another and within one person over time. Symptoms of multiple sclerosis may include bowel and/or bladder disfunction, changes in cognitive abilities, dizziness and vertigo, emotional problems, fatigue, difficulty in walking, numbness or "pins and needles," pain, vision problems, headaches, hearing loss, itching, seizures, spasticity, slurred speech, swallowing problems sclerosis, and tremors. Most individuals will experience only some of these symptoms and perhaps not at the same time.
Symptoms of multiple sclerosis usually appear in episodic acute periods of worsening (relapses, exacerbations, bouts or attacks), in a gradually progressive deterioration of neurologic function, or in a combination of both.
The most common presentation of multiple sclerosis is the clinically isolated syndrome (CIS). In CIS, a patient has an attack suggestive of demyelination, but does not fulfill the criteria for multiple sclerosis. Only 30 to 70% of persons experiencing CIS later develop multiple sclerosis. The disease usually presents with sensorial (46% of cases), visual (33%), cerebellar (30%) and motor (26%) symptoms. Many rare initial symptoms have also been reported, including aphasia, psychosis and epilepsy. Patients first seeking medical attention commonly present with multiple symptoms. The initial signs and symptoms of multiple sclerosis are often transient, mild, and self-limited. These signs and symptoms often do not prompt a person to seek medical attention and are sometimes identified only retrospectively once the diagnosis of multiple sclerosis has been made. Cases of multiple sclerosis are sometimes incidentally identified during neurological examinations performed for other causes. Such cases are referred to as subclinical multiple sclerosis.
The person with v can suffer almost any neurological symptom or sign, including changes in sensation (hypoesthesia and paraesthesia), muscle weakness, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, or diplopia), Fatigue, acute or chronic pain, and bladder and bowel difficulties. Cognitive impairment of varying degrees and emotional symptoms of depression or unstable mood are also common. The main clinical measure of disability progression and symptom severity is the Expanded Disability Status Scale or EDSS.
Multiple sclerosis relapses are often unpredictable, occurring without warning and without obvious inciting factors. Some attacks, however, are preceded by common triggers. Relapses occur more frequently during spring and summer. Infections such as the common cold, influenza, or gastroenteritis increase the risk of relapse.Stress may also trigger an attack. Pregnancy may affect susceptibility to relapse, offering protection during the last trimester, for instance. During the first few months after delivery, however, the risk of relapse is increased. Overall, pregnancy does not seem to influence long-term disability. Many potential triggers have been examined and found not to influence MS relapse rates. There is no evidence that vaccination for influenza, hepatitis B, varicella, tetanus, or tuberculosis increases risk of relapse. Physical trauma does not trigger relapses.
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