SYMPTOMS OF MS

The initial symptoms of MS are most often:

• difficulty in walking;
• abnormal sensations such as numbness or "pins and needles";
• pain and loss of vision due to optic neuritis, an inflammation of the optic nerve.

Less common initial symptoms may include:

• tremor;
• incoordination;
• slurred speech;
• sudden onset of paralysis, similar to a stroke;
• a decline in cognitive function—the ability to think, reason, and remember.

It is useful to divide the symptoms of MS into primary, secondary and tertiary categories.

Primary symptoms are a direct result of demyelination, the destruction of myelin—the fatty sheath that surrounds and insulates nerve fibers in the central nervous system. This impairs transmission of nerve impulses to muscles and other organs. The symptoms include weakness, numbness, tremor, loss of vision, pain, paralysis, loss of balance, and bladder and bowel dysfunction. Many of these symptoms can be managed effectively with medication, rehabilitation, and other medically-based methods.

Secondary symptoms are complications that arise as a result of the primary symptoms. For example, bladder dysfunction can cause repeated urinary tract infections. Inactivity can result in disuse weakness (not related to demyelination), poor postural alignment and trunk control, muscle imbalances (adaptive shortening and/or stretch weakness), decreased bone density (increasing risk of fracture), and shallow, inefficient breathing. Paralysis can lead to the secondary symptom of bedsores. While secondary symptoms can be treated, the optimal goal is to avoid them by treating the primary symptoms.

Tertiary symptoms are the social, vocational and psychologic complications of the primary and secondary symptoms. A person who becomes unable to walk or drive may lose his or her livelihood. The strain of dealing with a chronic neurologic illness may disrupt personal relationships. Depression is frequently seen among people with MS. It may be a primary, secondary, or tertiary symptom. Professional assistance from psychologists, social workers, physical and occupational therapists, and public health agencies is indicated for managing many tertiary symptoms.

It is important to remember that many of the symptoms of MS can be effectively managed, and complications avoided, with regular care by a neurologist and allied health professionals.