Early Signs of Multiple Sclerosis

There’s currently no definitive list of the early signs of multiple sclerosis (MS) and a first sign for one person may not be the first for another. The first symptom of MS may be numbness and tingling for one individual, while for another it’s dizziness, and for yet another it’s crushing fatigue.

But there are certain changes you should be aware of, especially if they’re persistent.

While no one symptom should trigger an immediate concern that you have MS, it’s good to know the signs and symptoms so that if you have them, you can get them checked out by a doctor.

The following are some common early symptoms of MS.

Vision Loss Eye pain and loss of vision in one or, rarely, both eyes can be among the first signs of MS, says Scott Ireland Otallah, MD, an associate professor of neurology at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. These symptoms are typical of optic neuritis, which is caused by an inflammation of the optic nerve. Other symptoms of optic neuritis include blurred vision and diminished color vision.

In most cases of optic neuritis, vision returns on its own or with steroid treatment.

This isn’t the temporary, pins-and-needles numbness that accompanies resting on an arm or leg in the wrong way, which lasts for seconds or minutes and goes away within a few minutes as blood flow returns to the area. Numbness or tingling associated with MS tends to develop over days or weeks and takes days or weeks to resolve, says Dr. Otallah.

While some symptoms of MS are very common, there’s no typical pattern of symptoms that applies to everyone.

The key to determining whether a symptom might be due to MS is how it develops, says Tanuja Chitnis, MD, a professor of neurology at Harvard Medical School and the director of the Mass General Brigham Pediatric MS Center at Mass General Hospital for Children, both in Boston.

MS symptoms develop slowly over the course of several hours or days, Dr. Chitnis says, and can last for several days to a few weeks.

Symptoms that come and go within minutes or persist for only a short time — but not for hours — are much less likely to be caused by MS.

MS attacks, or flares, are also likely to cause lasting neurological deficits, or abnormalities in the function of a body part or area, even after the worst of the symptoms have subsided.

A prodrome is a premonitory or warning phase of a medical problem yet to come. It’s an early stage of signs or symptoms that happens before the onset of the typical symptoms.

“Prodrome for MS has been discussed and studied more in recent years; 10 or 15 years ago, we didn’t necessarily think of MS as having a prodrome,” says Otallah.

There is now more evidence to suggest that there may be some symptoms that occur in people well before their first demyelinating event or MS diagnosis, he says.

Increased hospitalizations and medication use could also be a symptom of prodrome.

“There does seem to be an increase in depression, anxiety, and migraine prior to MS diagnosis, but all three of those conditions are also very common in the general population, and most of those people never go on to develop MS,” says Otallah.

These conditions, along with other suspected prodrome symptoms, aren’t being used to identify people who may be at an increased risk of MS yet, he says. “We’re not at a point where we can use these to predict if someone is going to go on to develop MS, but when we look back, we are noticing correlations.”

MS symptoms are varied and numerous. In addition to those described above, common symptoms include:

• Pain
• Bowel and urinary problems
• Sexual dysfunction
• Difficulty swallowing
• Speech problems
• Cognitive (thinking and memory) problems
• Depression

“Some of these symptoms are common to many disorders, but if you are experiencing any of these neurologic symptoms that develop over hours or days, you want to get that checked out,” says Otallah.

If you’re experiencing pain or numbness, don’t assume that it’s caused by something else, such as a pinched nerve, especially if there’s no reason for you to have a pinched nerve, says Otallah. “Even if it is a pinched nerve, you should probably get it checked out,” he adds.

Of course, any symptom that interferes with your job performance, daily functioning, or quality of life is worth discussing with your doctor, whether or not you suspect it’s related to MS.

But if it is MS, a diagnosis and speedy treatment are the best ways to get it under control, prevent relapses, and delay or prevent disease progression and future disability.

“Any part of the central nervous system [the brain, spinal cord, and optic nerve] can have a demyelinating lesion, and so you can have almost any symptom that could potentially be perceived as neurologic; that’s part of what can make diagnosis tricky,” says Otallah.

One encouraging development in MS care is that the time it takes to get a diagnosis is shrinking, though it can still be challenging, says Otallah.

• Early signs of multiple sclerosis (MS) can vary widely, but common symptoms include vision loss, numbness or tingling, and balance problems. While these symptoms do not definitively indicate MS, it is important to consult a healthcare professional for an accurate diagnosis.
• MS symptoms may develop gradually over hours or days and can be exacerbated by heat, so it’s essential to be vigilant about any persistent neurologic symptoms you may experience.
• If you experience these neurological symptoms significantly impacting your daily life or job performance, seek medical evaluation to rule out MS or other conditions. Early detection and prompt treatment can prevent relapses and slow disease progression, offering some reassurance amid the challenges.
• It’s also worth noticing cognitive changes or years of increasing healthcare visits for ill-defined symptoms, which may suggest a MS prodrome (a warning phase before the onset of typical symptoms). However, more research is needed to determine the reliability of these indicators for predicting MS.

Additional reporting by Connie Brichford.