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Many people who develop symptoms of multiple sclerosis (MS) aren't diagnosed for several years.
Typically MS causes a cluster of symptoms in one part of the body, and then goes away for several months to several years. Then it reappears as a different cluster of symptoms in another part of the body.
What kinds of symptoms may be the first signs someone has MS?
- It's not unusual for people who are in the very earliest stages of multiple sclerosis to develop paresthesia, a loss of sensation in part of the body.
- About 20 percent of people who have MS develop optic neuritis, loss of vision or color vision in one or both eyes, early in the course of the disease.
- It's also not unusual for people who are in the very earliest stages of the disease to present what appears to be bipolar disorder, except that the psychiatric symptoms almost resolve themselves. Either depression or euphoria unrelated to life events can signal the disease.
- Many people go to the doctor because they have odd twitches in the face, a condition called myokimia, or double vision that comes and goes.
- There can be spinal cord symptoms causing muscles first to become stiff (spastic), followed by painful cramps.
Multiple sclerosis can also manifest itself as dementia (usually only much later in the disease, although sometimes very early on), bladder problems, bowel problems, sexual difficulties, heat intolerance (problems with hot weather or with hot showers or overheated rooms), fainting, dizziness, or weakness of both sides of the face. MS is recognized by the Charcot triad, ataxia (loss of balance), dysarthria (difficulty speaking without difficulties finding words), and tremors. There can be problems with attention span, decision making, and judgment. Pain and fatigue are very common features of the illness.
Not everyone, however, develops all of these symptoms, and not everyone inexorably gets worse. Multiple sclerosis is typically diagnosed as:
- Relapsing-remitting (RRMS). About 85 percent of people who have MS have this form of the disease when they are diagnosed. All the symptoms go away for a time, and then come back, over a long period of time.
- Clinically isolated MS. These people present symptoms of MS once, and then the symptoms never come back again, even 10 to 20 years later.
- Secondary progressive MS (SPMS). After some years of relapse and remission, the disease reaches a point that symptoms only get worse. Most people who have RRMS eventually develop SPMS.
- Primary progressive MS (PPMS). Diagnosed in about 10 percent of people who have MS at their first presentation of the disease, symptoms only get worse with time. This group has more problems with changes in gait, stiff arms and legs, heavy legs, and inability to walk longer distances.
- Progressive-relapsing MS (PRMS). This form of the disease tends to cause more problems with bladder control, muscle spasms, vision changes, problems with speech, hearing loss, and tremors.
Most people who develop MS symptoms have to wait several years before they know whether they are destined only to get worse or maybe they are among the lucky few who have a form of the disease that doesn't get worse. Fortunately, there's now a test to determine who may be able to look forward to a life free from MS.