Let's Talk About Multiple Sclerosis Signs and Symptoms

Ask 10 peoplewith multiple sclerosis (MS) what their symptoms are, and you’ll likely get 10 different answers. While there are common challenges—eye problems, fatigue, trouble with gait and memory—exactly how and when you experience them will vary. Which means you might not know what to expect if you’ve recently been diagnosed with this autoimmune condition, and you could really have no clue what's happening if you haven't been diagnosed yet. The good news? We’re here to help. We’ll explain the range of possible MS symptoms that can warrant a trip to the doctor's (and give you a head's up on what might happen during a disease flare). And know this: Right now, you have more control over MS than ever before due to powerfully effective new treatments, plus a greater—and growing!—understanding of how to keep those symptoms at bay.

MS Signs and Symptoms

Our Pro Panel

We went to some of the nation's top MS experts to bring you the most scientific and up-to-date information possible.

梅根贝尔，博士。

Assistant Professor of Physical Medicine and Rehabilitation and Clinical Neuropsychologist

约翰霍普金斯医学多发性硬化症中心

Baltimore

布鲁斯科恩，M.D.

Chief of MS/Neuroimmunology, Department of Neurology

西北大学Feinberg医学院

Chicago

Neeta Garg, M.D.

Associate Professor of Clinical Neurology

University of Miami Miller School of Medicine

迈阿密

Remind Me: What’s MS, Again?

Multiple sclerosis is a type of autoimmune disease, which means that for unknown reasons the body’s immune system mistakenly attacks healthy tissues. In MS, the target is the myelin sheath, the protective tissue that surrounds the nerves in the central nervous system (CNS), which is comprised of the brain, spinal cord, and optic nerves.

当以这种方式从神经中剥离髓鞘时，发生疤痕（称为硬化症）。这伤害有助于普遍的MS症状 - 其中一些您可能正在经历的人 - 包括疲劳，眼睛疼痛，模糊的愿景，平衡和步态问题，麻木，以及焦点和浓度的麻烦。

为什么？这种疤痕中断从大脑行驶到身体的信号，有时甚至会导致信息丢失。由于疤痕在CNS调用中建立起来lesion burdenor病变负荷—MS symptoms can progressively worsen.

What Are the Different Types of MS?

在谈论症状之前，知道有许多不同类型的MS有助于。虽然具有不同类型的MS的人经常分享常见的症状，但它们可能会以不同的方式体验（或根本不会遇到一些症状），因为并非所有类型的MS都遵循相同的路径。以下是类型：

临床上孤立的综合征（CIS）

Technically, this isn’t MS—but it is a possible precursor to the disease. CIS is a special designation that describes the first flare-up of MS-like symptoms that may, or may not, be diagnosed as MS down the line.

The term CIS is used to describe a symptom attack, such asoptic neuritis(pain in the eye and vision loss) orspasticity(uncontrolled contractions of the muscles, usually in the arms and legs, caused by nerve damage) and it doesn't always cause pain. If a healthcare provider suspects that the symptoms may be caused by MS, he or she will usually order an MRI and conduct other tests to rule out other diseases. To be classified as CIS, the episode must last at least 24 hours and must show demyelination (when inflammation strips away myelin from nerves in the CNS).

Relapsing-Remitting MS (RRMS)

到目前为止，最常见的多发性硬化症疾病课程是RRMS，包括约85％的MS病例。具有RRMS意味着经历症状攻击时期，称为复发，耀斑或加剧 - 之后是部分或全部恢复的时期，称为剩余。

恶化事件必须持续至少24小时才能被视为复发，但它可以继续几周甚至几个月。对于每位患者来说，它也是不同的。对于每个人来说，这种循环重复的频率也会变化，但随时治疗，许多患者在爆发之间有几个月甚至几年。

二次逐步MS（SPM）

Until two or three decades ago, most people with RRMS would go on to developsecondary-progressive MS (SPMS)—meaning, they’d never again experience periods of remission, with symptoms always present. That’s changed dramatically in recent years for many people with RRMS, thanks to effective new MS therapies calleddisease-modifying treatments (DMTs)这是1993年首次推出的。

Left untreated, about 50% of people with RRMS develop SPMS within 10 years. Most researchers believe that number is far lower with DMT treatments, but there haven’t been any studies to confirm this lower rate of progression. Nowadays, when people with RRMS do go on to develop secondary progressive MS, it generally takes years, if not decades, to occur. Some DMTs can even slow the progression of SPMS itself. And, for people whodo发展SPM，也可以更有效地管理症状。

Primary-Progressive MS (PPMS)

If approximately 85% of people with MS start with RRMS, about 10% are affected by primary-progressive MS (PPMS). In general, people with PPMS experience few or no remissions with no symptom flare-ups—symptoms progressively worsen from the start. On rare occasions people with PPMS can go into remission.

Progressive-Relapsing MS (PRMS)

Affecting just 5% of people with MS, PRMS is the rarest form of the disease, known for its steadily worsening symptoms and acute (severe) relapses.

What Are the Symptoms of MS?

At its core, MS is a condition that harms the nerves of the central nervous system, or CNS. Damaged nerve fibers can’t transmit electrical signals efficiently, or sometimes at all, causing a wide range of physical and cognitive symptoms.

There is usually no telling what specific symptoms someone will develop when they have MS, although cognitive lapses and eye-related problems are often the first symptoms people experience. The different stages and types of MS sometimes share symptoms, although every person with MS is affected in his or own way. That said, if you have MS, here are some of the ways the disease might affect you.

认知问题

Problems with cognition and thinking are good examples of “invisible” symptoms—the ones that can profoundly affect you but that no one else picks up on right away. That said, cognitive symptoms are usually what get people to make that initial appointment with their doctor. They include having difficulty with:

• 保留和加工新的回忆

• Processing new information

• 注意细节

• Concentration

• 执行功能（一种描述和优先考虑的奇特方式）

• Copying or drawing shapes, figures, or lines

• Verbal fluency, which your ability to find just the right word, even a familiar one

Cognitive changes are common and can occur at any time—even in the first stages of MS, although they tend to worsen as the disease progresses. Fortunately, a range of treatment options, including daily brain exercises and other strategies, can help keep your mind sharp and engaged.

特色系列

MS: A Matter of Trust

Numbness and Tingling

Numbness and tingling are some of the most common symptoms of MS and are often among the first to show up. No mystery here—these symptoms are caused by the stripped myelin not allowing sensory nerves to transmit impulses back to the brain. Result? Lack of feeling.

虽然有些人有MS的人认为麻木是一个只是烦恼，但是当你烹饪时，你需要小心极度寒冷和热量 - 并且在防止受伤的伤害中你根本无法感觉到。（就像你拿起一个热板一样。）麻木可以阻止你甚至注意到你刚烧掉自己。

Vision Problems

愿景问题通常是MS的预警标志。视神经附着在眼睛的背面并直接向大脑发送信息。当免疫系统攻击视神经的髓鞘时，它被称为optic neuritis。

Pain behind the eye and a temporary loss of vision—usually in one eye only—are the main signs of optic neuritis. If you develop it, you’ll almost certainly know it and seek treatment, either from an eye doctor (optometrist or ophthalmologist) or a brain specialist (neurologist), ASAP. That’s because, when optic neuritis strikes, it usually causes undeniable discomfort. Here are some of the symptoms:

• 你会我ikely feel a constant ache or a “striking” sensation behind a single eye.

• 在同一只眼中，您可能还有明显的视力损失，包括模糊或双重视力;外围视觉丧失;丧失颜色视觉;昏暗的愿景（好像有人把灯弄下来）;甚至用眼睛运动闪烁或闪烁灯光。

虽然有可能具有视神经炎，但没有MS-Sette感染可能会导致这种眼部状况，而且如果您有光学性神经炎，并且一个或多个脑病变是also在MRI扫描中发现，可能会诊断MS。即使你别have brain lesions during a bout of optic neuritis, experiencing a single episode of ON gives you a 50% higher risk of developing MS during your lifetime. We know that's scary to hear, but simply knowing you might have a susceptibility to this condition can help you stay on top of any new symptoms. And that, our friends, can help you get diagnosed and treated much more quickly.

另一个上行：视力损失通常（和谢天地）来自视神经炎的临时。症状往往会恶化一到七天，然后在一到三个月的过程中改善。在严重的情况下，类固醇眼滴用于减少视神经的炎症。光学神经炎可以是一次性事件，永不回报。但是，在15％到20％的案件中再次罢工。

特色系列

MS任务控制

走！

乏力

乏力is a nearly universal symptom of MS. It’s thought to be at least partially connected to your body fighting inflammation, which uses up a lot of your energy. Even so, the exact cause of fatigue in people with MS is largely unknown. And it’s often misunderstood by coworkers and family members, who may think a person with MS is simply “down in the dumps” or is not trying hard enough to get out of bed to face the day. If only.

疲劳也会发生原因可能不是directly related to inflammation but rather are byproducts of it. For example, a person who has mobility issues might have to work harder to climb a flight of stairs. And because it can sometimes be rough to get uninterrupted sleep thanks to frequent bathroom runs (more on this in a bit), a person is going to end up pretty pooped.

但是，正式地，称为MS相关的疲劳lassitude。According to the National MS Society, this kind of severe fatigue:

• 倾向于每天发生

• May happen in the morning, even after a good night’s sleep

• Gets worse as the day progresses

• 通常因热和湿度而加剧

• 突然出现

• 干扰日常责任

与MS相关的疲劳部分可以部分地与抑郁症（更重要的是），因为角色炎症在慢性条件下起到像MS和其他炎症障碍等慢性条件下。

痉挛和痉挛

这种痛苦的肌肉加强影响了60％至90％的人（YEP，这是信号状况的大学之一）。有两种类型：

• Flexor spasticity, which occurs when the muscles that bring a limb toward your body tighten up. If your forearm flexors are impacted, your hand will curl into a claw.

• Extensor spasticity是相反的。它迫使你的肌肉延长a limb. In this case, your extensor muscles would prevent you from closing your fingers into a fist.

Spasms are something else—the involuntary contraction of muscles. You may experience both spasms and spasticity if you have MS, and just like every other MS symptom, they're caused by the interruption of nerve signals between your muscles and brain. Some of these electrical impulses get lost, so your muscles don’t get certain messages that help control them.

走路和步态困难

行走和移动的麻烦是MS的另一个常见症状。对腿部肌肉的神经损害可能导致弱点，痛苦的痉挛和麻木。大脑中对听觉神经的损坏可能导致眩晕，将世界放在旋转周期上。难怪和女士赶紧越来越难，更容易倒下。事实上，MS的人在没有MS的人的情况下尽可能多地翻滚三倍。

弱点全都

Weakness is common if you have MS, and it can stem from a number of sources. For starters, loss of myelin on the nerves that serve your body’s muscles may make those muscles work less efficiently, leaving you with a weakened feeling all over. In addition, the snowball effect of deconditioning may be at play: You’re weak so you don’t exercise, and you don’t exercise, so you grow weaker. It can be a bit of a vicious circle.

沮丧

Clinical depression is never just the blues, and people who battle it can’t just get over it. Depression affects people with MS at higher rates than people with other chronic diseases—even terminal ones. Specifically, 50% of people living with MS are also experiencing depression, which is two to three times higher than the general population.

It’s thought that depression in MS has many causes and pathways. One aspect is the upheaval to your life that happens when you’re diagnosed with a chronic condition like MS. You may think your life is over, and wonder how you will ever live with the disease. That’s a normal and understandable reaction, and the shock is enough to cause depression in some people.

然后存在炎症的作用。血液和其他实验室测试中发现的炎症生物标志物 - 可以在抑郁症的人中发现。临床诊断的抑郁症也会影响其他炎症条件，如类风湿性关节炎（RA）或CROHN病等炎症，表明炎症可能是抑郁症的关键因素。

Finally, people who develop lesions in the right frontal lobe of the brain—which plays a role in memory formation, personality, motivation, and more—are especially likely to be associated with depression, according to some research, including a study published inJournal of Neuropsychiatry and Clinical Neuroscience。

If you have MS and feel hopeless, don’t wait—talk to your doctor.If you need help right now, call the Substance Abuse and Mental Health Services Administration (Samhsa.的）hotline at 1-800-662-HELP (4357) for free, confidential, 24/7, 365-day-a-year treatment referral (in English and Spanish) for individuals and families facing mental health crises.

Pain and Itching

MS可以直接和间接引起疼痛。由MS的神经损坏引起的疼痛被称为neuropathic pain。It occurs when signals passing from nerve to nerve get short-circuited after they encounter an MS lesion.

Painful conditions caused by MS include:

• 三叉神经痛：The trigeminal nerve is the largest of the cranial nerves that give feeling to much of your face. Trigeminal neuralgia, also known as三叉神经痛, happens when MS attacks this pathway, and it can be extremely painful. There are medications that can help manage it.

• Lhermitte’s sign:这是一种电击感觉，当你向前弯曲颈部时，沿着头部和脊柱的背部撞击。它有时也可以击落胳膊和腿部，可能导致难以走路。Lhermitte的标志是MS破坏了你的颈椎（A.K.A.你的脖子）的线索。

• MS hug:Also known asbandingorgirdling, this is an uncomfortable feeling of tightness around the torso that may cause difficulty breathing and can result from muscle spasms, nerve damage, or both.

• 感觉迟钝:This is the term for abnormal sensations that occur because damaged nerves are sending signals incorrectly. It may manifest in the form of numbness, tingling, a burning sensation, or itching.

Tremors, Speech Problems, and Trouble Swallowing

Despite how different they may seem these symptoms often occur simultaneously. Why? Because they all relate to movement and are governed by similar parts of the brain. Tremors are involuntary movements of the limbs or head, and they're often accompanied by slurred speech and trouble swallowing (吞咽困难）。它认为，当大脑和丘脑被损坏的大脑区域发生损坏时，所有三种症状都会发生。这些区域部分控制运动，包括口腔和喉部的运动。当它们被MS病变损坏时，脸部，嘴巴和喉咙的肌肉并不总是正常工作，这增加了窒息的风险。

Bladder and Bowel Problems

Do you frequently feel like you have to “go”就在这一刻还发生这种情况，因为MS病变会破坏来自大脑的神经信号，膀胱和肠道 - 这种症状可能会感到毁灭，因为你可能会越来越多地控制缺乏控制，你选择减轻自己的疾病。有五个人有四个人有膀胱问题，可以包括：

• Urinating more frequently

• Having to go more urgently

• Feeling like you’re not done urinating

• 夜间排尿（nocturia的）

• Incontinence, or the inability to hold it in

肠问题可包括便秘，腹泻或肠尿失禁。

Sexual Dysfunction

根据患有MS的人的一项研究，据诊断出这种疾病后，63％的报告率较少。其他研究表明，91％的男性和72％的妇女有调查的女士报告的性问题。有MS的男人可能难以实现或维持勃起;MS的女性可能会降低阴蒂感觉。这可能是由几个因素引起的，包括脱髓鞘，这会影响与唤醒和性高潮有关的神经，以及以慢性病症为生的情绪变化和压力。虽然性问题可能导致您或您的伴侣在遇到它们时，基本生育率不会受到直接影响。

Much like depression, sexual problems can have more than one cause when you have MS. Part of it might be how the MS lesions on your brain are affecting your nerves that control the genitals, but part may also be related to the depression and anxiety often associated with MS, the upheaval of your life after a diagnosis, chronic fatigue, or loss of quality of life.

How Can Symptoms Lead to an MS Diagnosis?

Unfortunately, no matter what your constellation of symptoms may be, there is no single, defining test for multiple sclerosis. Rather, doctors will only conclude that you have MS after systematically ruling out other diseases—including Lyme disease, HIV, lupus, brain tumors, andspine conditions, to name a few—that might be causing your symptoms. When—and only when—all signs point to MS will you get what’s called a诊断排除or鉴别诊断。

这个过程有时可能需要数周或数月 - 记住，你的医生正在彻底，因为你的症状可以与许多其他条件相关联。如果您认为您正在遇到可能发出可能发出MS诊断的症状，请与您的医疗保健从业者交谈。你越早被诊断出来（或排除）MS，你能越早开始治疗并回到过你的生活。

满足我们的作家

Patrick Sullivan

Patrick Sullivan is a New Jersey-based freelance content writer and copywriter for healthcare providers, publications and brands. When he’s not chasing after his two small children, Patrick enjoys training Brazilian jiu jitsu, practicing yoga, reading and taking photos (poorly). You can find him at sullywrites.com.

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