Multiple sclerosis (MS), affects less than 0.1% of the global population. This condition primarily impacts the brain, spinal cord, and the optic nerve behind the eyes, causing various symptoms that often first appear between the ages of 20 and 40. How does MS begin, and what are its early signs? (1) 

Onset and Progression Patterns

There are two main patterns of symptom onset in MS: (2)

1. Relapsing-Remitting Pattern (most common - 85% of cases):
   Symptoms appear as sudden flare-ups (relapses) that partially or completely subside (remission) before recurring over time.

2. Progressive Pattern (less common - 15% of cases):
   Symptoms gradually worsen over time without clear relapses or remission periods.

Note:
In the relapsing-remitting pattern, symptoms often start suddenly over a few hours or days, peak within days, and gradually improve over subsequent weeks. A relapse typically lasts around eight weeks from onset to recovery. (3)

Early MS Symptoms

The first symptoms of MS vary widely between patients, depending on the location of nerve damage (spinal cord, optic nerve, or brainstem). Common early symptoms include:

• Numbness or Tingling: (4)
  Typically occurs on one side of the body, face, or below the waist.
• Weakness or Lack of Coordination:
  Weakness in one or more limbs can cause heaviness, difficulty moving, stiffness, or poor coordination.
• Visual Problems:
  These usually affect one eye and may include double or blurry vision, dull or faded color perception, pain during eye movement, or partial/complete loss of vision.

Other potential early symptoms:

• Persistent, unexplained fatigue.
• A sensation of an electric shock when bending the neck forward (Lhermitte's sign).
• Dizziness or balance issues.
• Cognitive challenges, such as trouble concentrating or mild memory issues.

Heat Sensitivity:
Hot weather, bathing in warm water, or having a fever may temporarily exacerbate existing MS symptoms. However, these changes are not permanent, and symptoms usually return to their prior state once the body cools down.

Advanced MS Symptoms

As MS progresses, it can lead to more severe symptoms affecting daily life. These may include: (5)

Mobility Challenges:

• Severe difficulty walking.
• The need for assistive devices like canes, walkers, or wheelchairs.
• Muscle weakness and stiffness (spasticity), potentially lead to paralysis in rare severe cases.

Speech and Cognitive Problems:

• Slow or slurred speech.
• Memory issues and trouble focusing.
• Inappropriate emotional responses, such as laughing or crying.

Bladder and Bowel Issues:

• Urinary incontinence or retention.
• Constipation or loss of bowel control.
• Increased risk of urinary tract infections.

Sensory Symptoms:

• Persistent numbness or tingling in various body areas.
• Heightened sensitivity to touch or nerve pain.

Severe Muscle Spasms or Stiffness:

Especially in the lower limbs.

Sexual Dysfunction:

• Reduced libido.
• Erectile dysfunction in men or difficulty achieving arousal in women.

Disease Progression: Can You Lead a Normal Life?

MS is an unpredictable disease, with its progression and impact varying greatly among individuals. However, many patients can live independent or near-normal lives for extended periods, especially with proper treatment. (4)

Disease Progression and Severity:

• Symptoms may remain mild or inactive for up to 10 years or more, especially in the early stages or with effective treatment.
• However, rapid disease progression may occur in certain groups, such as:some text
  • Men diagnosed in middle age.
  • Patients experiencing frequent, severe relapses.

Disability and Wheelchair Use:

• Thanks to modern treatments, 75% of MS patients do not require a wheelchair.
• Some may need mobility aids in the advanced stages of the disease.

Daily Activities and Independence:

• Around 40% of patients can continue their daily routines with minimal impact when receiving appropriate care.

Factors That Worsen MS Progression

1. Smoking: Smoking accelerates disease progression. Smokers with MS are more likely to experience severe disability compared to non-smokers.
2. Stress and Delayed Treatment: Both can exacerbate symptoms and speed up disease progression.

By adhering to treatment and making lifestyle adjustments, many MS patients manage their condition effectively and maintain a good quality of life.

To receive the best care, visit the Neurology Department at Dr. Soliman Fakeeh Hospital equipped with the latest technologies, and a globally specialized medical team.

References

1. Sage Journals - Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition
2. National MS Society - Types of MS
3. PMC- Multiple Sclerosis: It's Not The Disease You Thought It Was
4. MSD manuals - Multiple Sclerosis (MS)
5. NINDS - Multiple Sclerosis