Multiple sclerosis can cause a variety of symptoms varying significantly in severity and progression among individuals: changes in sensation (hypoesthesia), muscle weakness, abnormal muscle spasms, or difficulty moving; difficulties with coordination and balance; problems in speech (dysarthria) or swallowing (dysphagia), visual problems (nystagmus, optic neuritis, phosphenes or diplopia), fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or emotional symptomatology (mainly major depression). The main clinical measure in progression of the disability and severity of the symptoms is the Expanded Disability Status Scale or EDSS. The initial attacks are often transient, mild (or asymptomatic), and self-limited. They often do not prompt a health care visit and sometimes are only identified in retrospect once the diagnosis has been made after further attacks. The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (20%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%); but many rare initial symptoms have been reported such as aphasia or psychosis. Fifteen percent of individuals have multiple symptoms when they first seek medical attention.
Fatigue Fatigue is very common and disabling in MS. Some 65% of people with MS experience fatigue symptomatology, and of these some 15-40% report fatigue as their most disabling MS symptom. A 2023 study found that effect on fatigue was the most valued attribute of MS therapy, and that participants would accept six additional relapses in 2 years and a decrease of 7 years in time to disease progression to improve either cognitive or physical fatigue from "quite a bit of difficulty" to "no difficulty." The pathophysiology and mechanisms causing MS fatigue are not well understood. MS fatigue can be affected by body heat and this may differentiate MS fatigue from other primary fatigue. Perceived fatigue and fatigability (loss of strength) are regarded independently. Primary MS fatigue is sometimes called "lassitude". MS fatigue may reduce during periods of other MS symptom remission. Knowledge of MS fatigue pathophysiology, diagnosis and treatment is very limited.
Primary vs. secondary In some areas it has been proposed that fatigue be separated into primary fatigue, caused directly by a disease process, and secondary fatigue, caused by more general impacts on the person of having a disease (such as disrupted sleep).
Contributory factors to secondary fatigue Factors such as disturbed sleep, chronic pain, poor nutrition, or even some medications can all contribute to secondary fatigue and medical professionals are encouraged to identify and modify them.
Association with depression Early 2000s commentary saw a close relationship of secondary fatigue with depressive symptomatology. When depression is reduced fatigue also tends to reduce and it is recommended that patients should be evaluated for depression before other therapeutic approaches are used.
Correlation with brain changes Studies have found MS fatigue correlates, not with lesion volume or brain atrophy, but with damage to NAWM (normal appearing white matter) (which will not show on normal MRI but will show on DTI (diffusion tensor imaging)). The correlation becomes unreliable due to ageing in patients aged over 65. A 2008 study found MS fatigue correlated with lesion load and brain atrophy. A 2024 study found results suggested that fatigue was not driven by neuroinflammation or neurodegeneration measurable by current structural MRI in early RRMS.
Medications Medications used to treat MS fatigue include amantadine, pemoline, methylphenidate, and modafinil, as well as cognitive behavioral therapy (CBT) and psychological interventions of energy conservation; but their effects are limited. For these reasons fatigue is a difficult symptom to manage.
Technology As of 2022 apps were being experimented with in the field of MS fatigue.
Bladder and bowel Bladder problems appear in 70–80% of people with multiple sclerosis (MS) and they have an important effect both on hygiene habits and social activity. Bladder problems are usually related with high levels of disability and pyramidal signs in lower limbs. The most common problems are an increase in frequency and urgency (incontinence) but difficulties to begin urination, hesitation, leaking, sensation of incomplete urination, and retention also appear. When retention occurs secondary urinary infections are common. There are many cortical and subcortical structures implicated in urination and MS lesions in various central nervous system structures can cause these kinds of symptoms. Treatment objectives are the alleviation of symptoms of urinary dysfunction, treatment of urinary infections, reduction of complicating factors and the preservation of renal function. Treatments can be classified in two main subtypes: pharmacological and non-pharmacological. Pharmacological treatments vary greatly depending on the origin or type of dysfunction and some examples of the medications used are: alfuzosin for retention, trospium and flavoxate for urgency and incontinency, and desmopressin for nocturia. Non pharmacological treatments involve the use of pelvic floor muscle training, stimulation, biofeedback, pessaries, bladder retraining, and sometimes intermittent catheterization. Bowel problems affect around 70% of patients. Around 50% of patients experience constipation and up to 30% experience fecal incontinence. Cause of bowel impairments in MS patients is usually either a reduced gut motility or an impairment in neurological control of defecation. The former is commonly related to immobility or secondary effects from drugs used in the treatment of the disease. Pain or problems with defecation can be helped with a diet change which includes among other changes an increased fluid intake, oral laxatives or suppositories and enemas when habit changes and oral measures are not enough to control the problems.
Cognitive deficits
Deficits Some of the most common deficits affect recent memory, attention, processing speed, visual-spatial abilities and executive function. Symptoms related to cognition include emotional instability and fatigue including neurological fatigue. Cognitive deficits are independent of physical disability and can occur in the absence of neurological dysfunction.
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