Warning signs of multiple sclerosis (MS)

With multiple sclerosis still undiagnosed, symptoms can range from new and clearly disturbing physical changes that make it hard for you to function, to vague, familiar sensations that could be the result of any number of circumstances and are unlikely to cause immediate alarm. Nevertheless, it is important to recognize the suspicious signs of MS and to diagnose the disease as early as possible to take advantage of the many effective and early treatments now available.

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MS is a chronic and often disabling disease of the central nervous system that affects the brain and spinal cord. In the United States, more than 900,000 people are living with MS, according to the latest estimate published in the journal Neurology.

Symptoms can vary widely, and for the majority of people with MS, the signs of the disease come and go. Remission periods vary from person to person and can last as little as a week, or as long as months or years. This can mean that if symptoms are not recognized early, MS treatment can take years.

What symptoms should I look for?

  • Fatigue so extreme that it interferes with the ability to function at home and at work.
  • Numbness or tingling often felt in the chest, face, arms and legs.
  • Walking problems due to balance, muscle weakness, stiffness or fatigue.
  • Visual problems such as blurred vision and pain with eye movement.
  • Dizziness and lightheadedness with feeling unbalanced or dizzy.
  • Constipation or loss of bowel control.
  • Bladder problems.
  • Problems with cognitive function like short term memory and processing.

There are also less common symptoms including problems swallowing, uncontrollable shaking; speech problems (kneading, loss of volume, occasional stuttering), itching, tingling or burning sensations, headaches, breathing problems and hearing loss.

Symptoms unique to MS

With MS, “there are the more common symptoms, like loss of vision in one eye, that most people will get evaluated for fairly quickly,” says neurologist Dr. Jennifer Orthmann-Murphy, assistant professor. in Neurology at the Mahoney Institute of the University of Pennsylvania. for neuroscience and an expert in multiple sclerosis. “It can be associated with optic neuritis, which is a common symptom of MS. But the first step to take if you lose your vision is to get it checked out.

Something known as “MS hug” is another disturbing experience. “It’s a kind of squeezing feeling around your torso that can happen at any level,” says Orthmann-Murphy. “It corresponds to a spinal cord injury. It’s like getting a hug, but it’s a weird, tight feeling. The feeling of a spinning room or double vision is also a sign of MS, she notes.

However, other signs of MS are easier to dismiss, at least initially, because there is overlap with several possible causes. However, certain characteristics, such as unilaterality, can indicate MS.

“These are the more insidious symptoms, like numbness or tingling on one side of the body, or just in the leg,” says Orthmann-Murphy. “Sometimes you can wake up in the morning with it and think you slept badly, or that sort of thing. If it’s related to MS, it lingers for a week or two and then goes away on its own. That’s when you start to wonder what that episode was really about.

Imbalance can be another vague but persistent symptom of MS. “It’s like tripping over things or feeling like you’re walking on a boat,” says Orthmann-Murphy. “When it comes on slowly, it can be very confusing. And it can be more subtle, where you fall more often when the lights are off, or that sort of thing. It can actually be a sign of a brain injury. spinal cord.

“Because symptoms can be illusory, the onset of MS can be misdiagnosed or overlooked for years,” says Dr. Lauren Krupp, professor of neurology and director of NYU Langone. Comprehensive multiple sclerosis care centre. “But once the patient has seen a neurologist, a medical history and MRI will be taken, and if it is MS, telltale scars (lesions) on the brain or spinal cord will appear.”

“Whatever symptoms you’re experiencing, a good rule of thumb is to go to the doctor when things don’t seem right,” says Krupp. “If your diagnosis is MS, the type you have will likely be identified as well.”

Individual effects

“MS affects the immune system by attacking the protective sheath (myelin) that covers nerve fibers and disrupts communication between the brain and the rest of the body,” says Dr. Bardia Nourbakhsh, assistant professor at the Multiple Sclerosis Center at Johns Hopkins Medicine. in Baltimore.

MS makes itself felt and worsens health before people even know they have it. People who are eventually diagnosed with MS tend to need more medical care in the years leading up to that diagnosis, Nourbakhsh says. During this window, studies show that people have more emergency room visits for neurological symptoms, and more doctor visits and prescriptions filled, one to five years before diagnosis.

The specific cognitive problems associated with MS tend to be changes in short-term memory and processing speed, Nourbakhsh says. Such changes are subtle, he adds, and are identified by specialized tests in some people who have been diagnosed with MS.

“Nevertheless, the diagnosis of MS requires having typical symptoms, which usually include what are called MS attacks,” says Nourbakhsh. “Things like acute vision loss, dizziness, numbness, tingling, weakness and bladder and bowel dysfunction that last a long time – days to weeks, not seconds or minutes.” For people with these symptoms, an MRI of the brain and spinal cord and analysis of the cerebrospinal fluid help in the diagnosis, he says.

“MS is a disease that varies from patient to patient,” Nourbakhsh points out. “You will rarely meet two patients with the same experience. Some patients are diagnosed with MS and have no residual, persistent, chronic or invisible symptoms. They lead a perfectly normal life and they are in perfect health.

However, he adds, other patients have residual symptoms from their attacks and they have chronic symptoms that persist and affect their quality of life and overall health. The good news, says Nourbakhsh, is: “Now we have so many options to try to tailor the treatment to specific patients.”

Improved processing

Less than a decade ago, Orthmann-Murphy says there were a “handful of drugs” available to treat MS. Now, in contrast, “we have so many drugs that we actually have our own dates just to (discuss) drugs.” With over 23 medication options, she says, “You just can’t crush this information into a 10-minute discussion – it’s just not fair to make this important decision.” At this point we have injectable, oral and infusion options that are very effective. »

The treatments work by modifying the immune system to prevent it from causing further damage, says Orthmann-Murphy. The earlier MS can be diagnosed and treatment started to prevent as little damage as possible, the better patients can do. “I tell my patients that my goal for our appointments is to be very boring – because everything is fine,” she says.

Types of MS

The National MS Society classifies four types of MS:

  • Clinically isolated syndrome. The CIS describes the first episode of neurological symptoms. It must last at least 24 hours, but will not necessarily lead to a diagnosis of MS unless lesions are visible on a brain MRI. An individual in this case has a high probability of a second episode of symptoms and a diagnosis of MS.
  • Relapsing-remitting MS. About 85% of people with RRMS are initially diagnosed with this form of MS. It is characterized by periods of active symptoms alternating with periods of remission, during which symptoms are less severe or may even disappear for a while.
  • Primary progressive MS. PPMS is a rare form and progresses early on without acute flare-ups or remissions of symptoms. Between 10% and 15% of people with MS are diagnosed with this type.
  • Secondary progressive MS. Over time, some people diagnosed with RRMS develop SPMS, in which flare-ups of symptoms continue, new symptoms may appear, and the disease progresses steadily, leading to gradually increasing levels of disability.

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