When to Suspect MS

Multiple sclerosis (MS) is like an infamous masquerader. So-named for sclerosis, or scarring, that occurs in unpredictable places throughout the central nervous system, an MS diagnosis can elude patients and their clinicians for a long time before finally being uncovered. However, information is power. In honor of MS Awareness Week (March 7-13), consider the telltale signs and symptoms of multiple sclerosis, as well as some of its lesser-known presentations.

The Typical MS Diagnosis Profile

Multiple sclerosis, which researchers believe is an autoimmune response against the protective myelin sheath that coats nerve cells, disproportionately affects women of child-bearing age. The most likely age of onset of MS is between 20 and 40 years old, and women are three times more likely than men to be diagnosed with MS, according to the U.S. National Library of Medicine. Genetics may play a role in MS, too. Researchers have found that MS is more likely to occur in people who have a family member with the condition.

The Most Common Signs and Symptoms of MS

When MS signs and symptoms arise, they can range from mild to severely debilitating. Multiple sclerosis can cause lesions in any place along the central nervous system (which includes the brain and spinal cord), but it preferentially affects certain areas, causing the following classic symptoms:

• Visual changes: A visual change is often the first symptom of MS. When an MS lesion involves the optic nerve, patients can experience visual changes such as double vision, blurry vision, painful eye movements, a decreased ability to discern color, or even partial blindness.
• Numbness or tingling: A feeling of decreased sensation, or altered sensation, in a body part such as the arms, legs, or face, is one of the most common initial symptoms of MS.
• Fatigue: This symptom can occur in up to 80% of people diagnosed with MS, according to the National MS Society.
• Muscle weakness and balance problems: Muscle weakness in MS can occur from deconditioning (the muscles grow weak from lack of use) or from direct damage to the nerves that innervate the muscles. Muscles can be spastic and cause problems with balance, leading to falls.
• Mood changes: Depression is another one of the most common symptoms of MS, according to the National Institute of Neurological Disorders and Stroke.
• Pain: More than half of patients may report significant pain from their condition, according to the National MS Society.
• Cognitive difficulties: Changes such as decreased attention, memory, or concentration can occur in more than half of people with MS, according to the National MS Society.
• Bladder problems: When MS lesions disrupt the communication between the brain and the muscles of the bladder, problems such as incontinence or overactivity can result. In fact, up to 80 percent of people with MS may experience bladder problems at some point.

Other, less common, symptoms of MS include hearing loss, speech impediments, seizures, swallowing problems, and breathing problems.

Considering an MS Diagnosis

One of the most difficult realities of MS is that its initial symptoms are often subtle or vague. Patients may dismiss the random manifestations of an MS flare, especially if they are global, such as fatigue or depression. When patients do present to a medical provider to address a specific symptom, such as numbness or tingling in the hands, it can be initially misattributed to another condition, such as a peripheral nerve compression syndrome.

What to Do if You Suspect You May Be Experiencing the Onset of MS

Many medical conditions present similarly to MS so, if you are experiencing any of the above symptoms, it is important to visit with your medical provider to undergo a comprehensive neurologic assessment. A clinician can carefully listen to the description of your symptoms and their timing and integrate your previous medical history and other contextual elements to formulate a potential diagnosis. Your clinician may recommend that you see a neurologist for further evaluation through imaging, lab work, and assessment of the fluid of your spinal cord.

What to Do if You are Diagnosed With MS

Even though a diagnosis of MS is intimidating, there is a lot of room for optimism. Staying vigilant and being your own health advocate can make all the difference when it comes to identifying and conquering this elusive condition. Though there is no cure for MS, there are many effective treatments available and an early diagnosis can help prevent further problems.

Libby Pellegrini is a nationally certified physician assistant. She has worked in numerous healthcare settings, including the rural United States, an inner-city Level I trauma center, several suburban acute care centers, and a boutique, personalized medicine clinic in Southeast Asia. She graduated Magna Cum Laude from Northwestern University’s Medill School of Journalism.

References:

https://www.nationalmssociety.org/Get-Involved/Raise-Awareness#section-1

https://www.ncbi.nlm.nih.gov/books/NBK499849/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241505/

https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Vision-Problems

https://www.ninds.nih.gov/Disorders/All-Disorders/Multiple-Sclerosis-Information-Page

https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms#section-0

https://www.wellrx.com/health-conditions/about/health-condition/carpal-tunnel-syndrome/~default/