Multiple
Sclerosis Symptoms The symptoms of multiple sclerosis are as varied as
is the distribution of the demyelination lesions throughout the CNS and the spinal
cord. Common sites that are affected are the tracts of the white mater of the
lateral and posterior columns of the cervical and thoracic spinal cord, the midbrain
area, the pons and the cerebellum, but also the gray matter in the cortex of the
brain and in the spinal cord. The optic nerves and the periventricular areas are
also frequently affected (Ref. 3, p. 1474).
Early MS Symptoms Yet
other cases may start with a mild gait disturbance, with loss of bladder control
or with a mild emotional disturbance. If this first attack of multiple sclerosis
is overlooked, it may take months or years before another attack strikes, this
time usually in another location. The neurologist, who likely will now be consulted,
in all probability will make the diagnosis, at least on a tentative basis. Sometimes
it takes several attacks before the diagnosis is made correctly as initially the
symptoms can disappear between attacks. The difficulty with this disease is that
it is diffuse due to the variable location of the demyelination foci as explained
above, and with mild initial cases people may not even see their physician, denying
that there is a problem. In other cases the doctor may call the patient falsely
"hysterical". With the first attack there is usually
only a very localized area affected, which would manifest itself by a clumsiness
of a hand or a leg. In another case this first manifestation of multiple sclerosis
would be a double vision(=diplopia), if the brain stem tracts are affected, which
connect the 3rd, 4th and 6th cranial nerves that are all necessary for smooth
eye movements. |
Chronic MS Symptoms When
symptoms no longer disappear, but leave a weak leg behind that leads to a permanent
limp, and then is followed by another bout that leaves the patient with double
vision, then it is clear that there are at least two different foci with demyelination.
This is characteristic for multiple sclerosis, where as we mentioned above there
are disseminated foci of that nature throughout the CNS and the spinal cord. There
are a multitude of symptoms that are now commonly occurring. Mentally a lack of
judgment, apathy, depression and inappropriate emotional reactions are characteristic.
Slow speech with hesitation at the beginning of a word is common later into the
disease. Visual disturbances with field defects and even blindness and pain on
one eye (due to retrobulbar optic neuritis)can occur on top of the double vision
already mentioned. Uncoordinated, jerky eye movements (=nystagmus )can occur sometimes.
Face numbness can happen on one side; dizziness with preserved hearing can occur
as well. The motor and sensory system throughout the body can be interrupted
at the level of the spinal cord or at the level of the gray matter of the brain,
wherever the demyelination foci are located. The lesions can also be located in
the cerebellum, which is the part of the brain situated in the back of the skull
and is responsible for coordination of the muscle movements and also for the sense
of balance. If the lesions occur at this level, gait suddenly becomes a problem
as does balance. A tremor that becomes worse when the person intends to move or
actually moves is also a sign of cerebellar involvement (=intentional tremor).
Muscles become weak and spastic. There can be a stroke like picture with hemiplegia
with cerebral gray matter lesions. Fleeting sensor changes of the hands and feet
are common. A disturbing painful sensory disturbance happens with spinal cord
demyelination: a lightening type sharp pain shooting down the spine, which is
perceived as an electrical shock or as a burning or stinging pain along the mid
back. The autonomic nervous system, which controls bladder function and watches
over fecal continence, can also be affected. This is usually a late sign of multiple
sclerosis and means that the lesions are at the level of the spinal cord. Urinary
incontinence might be mild in the beginning, but in time it will lead to the need
for self-catheterization and eventually to continuous catheterization. Constipation
is common, but towards the later stages fecal incontinence may happen. In men
erectile dysfunctions occur commonly and in women a lack of feeling in the clitoris.
Many patients are heat sensitive and exposure to high fevers from flus
should be minimized by fever reducing acetaminophen. In summer a good air conditioning
unit is important to prevent a flare-up of a multiple sclerosis attack. |
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Disclaimer This
outline is only a teaching aid to patients and should stimulate you to ask the
right questions when seeing your doctor. However, the responsibility of treatment
stays in the hands of your doctor and you. References 1.
Z Liu et al. J Neuroimmunol 2001 Jan 1;112(1-2): 153-162. 2. C Liu et al
J Neurol Sci 2000 Dec. 1; 181(1-2): 33-37. 3. The
Merck Manual: Multiple sclerosis 4. Ferri: Ferri's Clinical Advisor:
Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc. 5.
Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier Last
Modified: Feb. 10, 2010 | |
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