Key takeaways:
Multiple sclerosis (MS) is an autoimmune condition that affects the brain and spinal cord.
MS often affects people differently. Some more common early warning signs include vision changes, balance trouble, or numbness and tingling in the arms or legs.
Recognizing the early symptoms of MS can help with early diagnosis and treatment. There are many medical treatments available to help to slow the progression of MS.
Multiple sclerosis (MS) is an autoimmune condition that affects the brain and spinal cord (central nervous system). It can lead to changes in your vision, balance, and strength. About 1 million people in the U.S. have MS. And it’s three times more common in women than in men.
Unfortunately, there’s no cure for MS. But the good news is that treatments are available, and they can help slow disease progression. This means that diagnosing MS and starting medication early can have an effect on how quickly symptoms worsen.
Here’s a guide to the early warning signs of MS, including what they look like and when to seek help.
What are the early warning signs of MS?
The early symptoms of MS aren’t specific to MS. This means they can be seen in other conditions. The first signs of MS are the same in both women and men, although no two people experience MS the same way. But there are some telltale signs and symptoms to be aware of.
Let’s take a closer look at some of the most common early signs of MS.
1. Eye pain, vision changes, or vision loss
Optic neuritis is inflammation of the optic nerve, which connects your eyes to your brain. It’s common in MS. About half of all people who are diagnosed with MS will experience this.
Symptoms of optic neuritis include:
Blurry vision
Pain when moving your eye(s)
Washed out color vision
Loss of vision (full or partial)
2. Double vision
Diplopia (double vision) is also a common symptom of MS. Typically, you’ll notice if you cover one eye that you can see clearly. But if you leave both eyes uncovered, you have double vision.
This can happen when MS affects parts of your brain that interpret what you see. It can also happen when the nerves that control your eye muscles are affected.
3. Numbness and tingling in the arms or legs
Sensations of paresthesia (tingling or numbness) are common early symptoms of MS. This can feel uncomfortable, bothersome, or even painful. Paresthesia typically affects the arms or legs, but it’s possible to feel it anywhere, including the face. Some people also notice loss of sense of vibration, pain, and touch.
4. Limb weakness
Muscle weakness is another possible early symptom of MS. It can be subtle, so you might just feel clumsy or like you’re tripping a lot. Many people don’t recognize that they have it until they’re tested for strength by a neurologist. The weakness is often in a hand, arm, or leg. It can also be severe enough that it affects walking or causes some paralysis. Muscle spasms may also come along with weakness.
5. Problems with balance and dizziness
Balance issues are common in MS. This can be due to issues in the inner ear, vision changes, brain processing, or any combination of these.
MS can also make you feel dizzy, which affects your balance. Feeling off balance and dizzy can make it difficult to get around or even change positions.
6. Bladder or bowel control problems
MS can affect the parts of the nervous system that control both the bladder and bowels. Bladder control problems are rarely the first sign of MS. But almost 70% of people with MS will have bladder problems at some point. Bladder problems can range from urinary urgency (suddenly needing to pee) to urinary incontinence (peeing unexpectedly). Bowel problems can range from constipation to loss of control. These issues can severely affect quality of life.
7. Fatigue
Fatigue, or extreme tiredness, is also a common symptom of MS. But, like some symptoms, it’s nonspecific, meaning there are many things that can cause fatigue. It’s not clear why fatigue is such a problem for people with MS.
What is clinically isolated syndrome (CIS)?
Clinically isolated syndrome (CIS) is a term for the first episode of MS symptoms. Basically, CIS looks like an MS attack, but it happens in someone who’s never had these symptoms before.
One episode of symptoms isn’t enough to make a diagnosis of MS. So, CIS is a complicated way of saying, “It could be MS, but we have to wait and see.”
CIS symptoms:
Last at least 24 hours
Aren’t easily explained by another infection or illness
Are due to inflammation in the brain or spinal cord (seen on MRI)
It’s possible to have only one symptom, which is referred to as a monofocal episode. And it’s also possible to have more than one symptom at once, called a multifocal episode.
Can clinically isolated syndrome turn into MS?
Some people recover after CIS, meaning that they don’t have MS. But, for many people, CIS will progress to MS.
If you’ve had a diagnosis of CIS, the risk of you having MS is higher if:
CIS occurred at a younger age. (There’s no specific threshold for age.)
CIS is multifocal (multiple symptoms at the same time).
MRI shows evidence of damage to myelin in the brain or spinal cord.
Certain proteins, called oligoclonal bands, are found in the cerebrospinal fluid (CSF), which is the fluid that bathes your brain and spinal cord.
If you’ve had an episode of CIS, and you’re waiting to find out if it could be MS, you may be feeling scared and in limbo. Your care team can guide you through next steps, and it may help to get peer support (more on this below).
What are the most common symptoms of MS?
MS can cause a wide range of symptoms, and it can start with any of them. But the most common symptoms of MS include:
Fatigue (extreme tiredness)
Trouble concentrating
Vision problems
Numbness or tingling in any of your limbs
Weakness that makes it difficult to walk
Loss of coordination
Trouble controlling your bowels and/or bladder
Feelings of depression or anxiety
Stiffness in your limbs, called spasticity
Pain from nerves, called neuropathic pain
At what age does MS usually start?
In most people (about 60%), MS is diagnosed between the ages of 20 and 50.
Are there any treatment options for symptoms of MS?
There are many ways to treat MS, and it’s often through a multidisciplinary approach. This means that a care team with many different specialties takes part in your care.
The care team at specialized MS centers will include a neurologist, a pharmacist, a physical and/or occupational therapist, and a psychologist. These specialists can offer different interventions, based on your needs.
Medications
Many disease-modifying therapies (DMTs) are available to help manage MS symptoms. The goal of DMTs is to reduce the number and severity of relapses and help you maintain your quality of life.
Medications for MS come in different forms:
By mouth: Oral medications include teriflunomide (Aubagio) and dimethyl fumarate (Tecfidera, Vumerity).
Injections: Injectable DMTs include glatiramer acetate (Copaxone, Glatopa) and ofatumumab (Kesimpta).
Infusions: These medications include natalizumab (Tysabri, Tyruko) and ocrelizumab (Ocrevus).
A newer treatment on the horizon is stem cell transplant for MS. This treatment aims to “reset” the immune system, so it no longer attacks the nervous system. Researchers are continuing to investigate new therapies and strategies, including restoring damaged myelin.
Physical and occupational therapy
Physical therapy (PT) and occupational therapy (OT) are important components of MS care.
Physical therapists work with you to improve balance, range of motion, and strength. They can develop a treatment plan to help your mobility and decrease the risk of falls.
Occupational therapists can help with coordination and strength issues. The goal is to help you do day-to-day activities and to support your independence.
Both PT and OT treatments may include assistive devices or orthotics (such as braces and shoe inserts) to improve ambulation, function, and independence.
Pain management
It’s common to experience different types of pain early on and as MS progresses. In many cases, a pain specialist can help. There are many medications and non-medical treatments to help manage your pain and improve your quality of life.
Mental health
Living with a chronic medical condition, like MS, can be stressful. It’s important to look after your mental health while taking care of your MS. A psychiatrist, psychologist, or other therapist can help manage the depression and anxiety that might accompany dealing with MS.
Resources
If CIS or MS is new to you, or even if it’s not, you may feel overwhelmed. If so, getting support may help.
Learn about ways to connect with others with MS, as well as helpful resources and services in your area:
When should I seek care if I’m worried I may have MS?
If you have any of the symptoms above, don’t hesitate to get evaluated. Experiencing these or other symptoms can be scary. But getting help early is important. If it’s MS or CIS, starting treatment as soon as possible can make a big difference. Many studies have shown that early treatment can help delay disability related to MS and reduce attacks.
It’s understandable to feel overwhelmed in the face of uncertainty. It’s best to get medical attention anytime you’re having symptoms that you can’t make sense of. A healthcare professional can help you get to the bottom of things and point you in the right direction, if you need more testing or a specialist referral.
Frequently asked questions
Experts aren’t sure exactly what causes MS. The most widely accepted theory is that some people are predisposed to it via their genes. And when they’re exposed to something in the environment, it triggers the immune system to react. Research has uncovered risk factors, such as low vitamin D levels and certain viruses.
Unfortunately, there’s not one specific test for MS. Rather, it’s a matter of ruling out other possible causes and determining that your symptoms and imaging findings meet the criteria for MS. The process involves meeting with a neurologist, who performs a detailed physical examination and orders other tests. This includes an MRI of your brain and spinal cord, and sometimes a lumbar puncture (spinal tap).
Experts aren’t sure exactly what causes MS. The most widely accepted theory is that some people are predisposed to it via their genes. And when they’re exposed to something in the environment, it triggers the immune system to react. Research has uncovered risk factors, such as low vitamin D levels and certain viruses.
Unfortunately, there’s not one specific test for MS. Rather, it’s a matter of ruling out other possible causes and determining that your symptoms and imaging findings meet the criteria for MS. The process involves meeting with a neurologist, who performs a detailed physical examination and orders other tests. This includes an MRI of your brain and spinal cord, and sometimes a lumbar puncture (spinal tap).
The bottom line
MS is a progressive condition that affects the central nervous system. Signs and symptoms of MS vary from person to person. Common signs and symptoms include changes in vision, sensation, strength, and balance. Early diagnosis is key to early treatment and possibly slowing the progression of MS. If you think you may be experiencing symptoms of MS, talk to your primary care provider. They can help walk you through the next steps for figuring out what’s causing your symptoms.
Why trust our experts?
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