Early Warning Signs of Multiple Sclerosis (MS) — And Why You Shouldn’t Ignore Them

Multiple sclerosis (MS) is a condition affecting the brain and spinal cord (central nervous system). It can lead to changes in your vision, balance, and strength — affecting your ability to walk. About 1 million people in the U.S. have MS, and it is 3 times more common in women. 

Unfortunately, there is no cure for MS. But the good news is that treatments are available, and they may 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 usually the first signs of MS?

The symptoms experienced in MS are not 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 because MS affects the central nervous system, 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

About half of all people who are diagnosed with MS will experience optic neuritis. Optic neuritis is inflammation of the optic nerve. And it’s the most common first sign of MS. Symptoms of optic neuritis include:

• Blurry vision

• Pain when moving the eye

• Washed out color vision

• Loss of vision (full or partial)

2. Double vision

Double vision (diplopia) is also a common symptom of MS. Typically, you will notice if you cover one eye that you can see clearly. But if you leave both eyes uncovered, you have double vision.

It can happen when MS affects parts of your brain that interpret what you see. It can also happen when the nerves going to the eye muscles are attacked.

3. Numbness and tingling in the arms or legs or face

Tingling or numbness (paraesthesia) of the arms, legs, or face is a common first symptom of MS. One study found that 40% of people with new-onset MS had numbness or tingling as their first symptom. Some people also notice loss of sense of vibration, pain, and touch.

4. Limb weakness

Muscle weakness is a common early symptom of MS. Weakness is a nonspecific symptom, and many people don’t recognize they have it until they’re tested for strength by a neurologist. The weakness is often in the hands and legs. 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

Inflammation of parts of the inner ear can lead to balance problems and dizziness. A person with balance problems or dizziness may be unsteady when they walk (ataxia) or appear clumsy. 

Balance issues are common in MS. About 80% of people with MS have some degree of ataxia. But in many cases, it is mild and may not have a major impact on quality of life.

6. Bladder control problems

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). Bladder control issues can severely impact a person’s quality of life.

What is clinically isolated syndrome (CIS)?

When a person experiences symptoms that could be MS, but they have never had an episode of MS before, it often gets labelled as “clinically isolated syndrome (CIS).” This is a complicated way of saying, “It could be MS, but we have to wait and see.” 

CIS is what the first episode of MS symptoms is called, when you don’t know if you have MS for sure. Basically, CIS looks like an MS attack, but it happens in someone who has never had these symptoms before. 

Keep in mind that any neurologic signs and symptoms could be a first episode of MS. With CIS, they last at least 24 hours and aren’t easily explained by another infection or illness.

It’s possible to have only one symptom, which is referred to as a monofocal episode. On the other hand, it’s 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 some people, CIS will be their first of many episodes of MS. 

Will I get MS?

If you’ve had an episode of CIS, and you’re left wondering — and waiting to find out — if it could be MS, you may be feeling scared and in limbo. Not everyone with an episode of CIS has MS, but some do. 

If you’ve had a diagnosis of CIS, the risk of you having MS is higher if:

• CIS occurred at a younger age (this study compared people younger or older than 30 years old, but there is no clear cutoff).

• 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.

At what age does MS usually start?

In most people (70%), CIS happens between the ages of 20 and 40.

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 ones 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

What causes MS?

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 are exposed to something in the environment, it triggers the immune system to react. Although it is not directly inherited, genetics play a part.

Based on years of research, certain risk factors have been identified. And because newer treatments that target the immune system work fairly well, this supports the autoimmune theory. 

How is MS diagnosed?

Getting an MS diagnosis usually involves seeing a neurologist or a specialist in conditions of the nervous system. Unfortunately, there is no 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 most recent criteria say that, in order to make a diagnosis, there must be:

• Evidence of two separate areas of damage in the nervous system

• Evidence that the damage occurred at separate points in time

• No evidence that your symptoms are caused by something else

In order to meet these criteria, the process often takes a few steps: 

1. First, your neurologist will start by asking you questions about your symptoms, medical history, and your family’s medical history, among other things. 

2. Next, they will perform a thorough physical examination before moving on to other tests. These will include an MRI, an imaging test that looks at your brain and spinal cord. 

3. Your neurologist will also test your blood and CSF. 

Why is early detection and treatment important for MS?

The process of getting a diagnosis can be frustrating, and experiencing these symptoms can be scary. It’s understandable to feel overwhelmed in the face of uncertainty. But it’s important to know that getting a diagnosis and starting treatment as soon as possible can make a big difference. Many studies have shown that starting treatment as early as possible is critical. It can help delay disability related to MS and reduce attacks.

Are there any treatment options for symptoms of MS?

There are many ways to treat MS and it is 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 or occupational therapist, and a psychologist. Other team members may be included if needed. 

The care team specialists can offer different interventions, based on your needs. MS centers around the country coordinate the different specialists to make sure each patient gets a personalized treatment plan.

Let’s take a look at some aspects of a treatment plan.

Medications

Unfortunately, MS can’t be cured. But there are many disease modifying therapies (DMTs) available to help manage the symptoms. The goal of DMTs is to reduce the number of relapses you have and help you maintain your quality of life. Medications may be taken by mouth (oral), injection, or infusion. 

Some of the more common oral DMTs for MS include:

• Teriflunomide (Aubagio)

• Dimethyl fumarate (Tecfidera, Vumerity)

• Mavenclad (cladribine) 

• Zeposia (ozanimod)

• Mayzent (siponimod)

Some of the more common injectable DMTs for MS include:

• Interferon beta-1a (Avonex, Plegridy, Rebif)

• Interferon beta-1b (Betaseron, Extavia)

• Glatiramer acetate (Copaxone, Glatopa)

• Kesimpta (ofatumumab)

Some of the more common infusion DMTs for MS include:

• Natalizumab (Tysabri, Tyruko)

• Ocrevus (ocrelizumab)

• Lemtrada (alemtuzumab)

• Mitoxantrone (Novantrone)

• Briumvi (ublituximab)

Stem cell transplantation (HSCT, or haematopoietic stem cell transplantation) isn’t a common treatment for MS, but it’s showing promise for future use. HSCT works by calming the parts of the immune system that cause inflammation. Stem cells seem to work best for people who are early in their diagnosis, have frequent relapses, and have active inflammation. Stem cell therapy is very expensive and not readily available. But research is ongoing.

Physical therapy

Physical therapy (PT) can be an important component 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.

Pain management

If you experience pain that you can’t manage, a pain specialist can help. They may try medications and non-medical treatments to help manage your pain and improve your quality of life.

Orthotics

Orthotics are assistive devices that can help you manage daily activities with MS. While they may not help with balance, they may help to improve mobility. Canes, knee and wrist braces, and shoe inserts are some examples of orthotics. Some orthotics can be bought ready-made. But most orthotics need to be custom-made to make sure they fit you perfectly.

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.

Why trust our experts?

Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Our editorial standards

Meet our experts