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{{Template:Multiple sclerosis}}
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==Overview==
==Overview==
The most common [[symptoms]] of multiple sclerosis include: [[Fatigue]], [[mood]] problems, [[spasticity]], [[bowel]], [[bladder]] dysfunction, [[cognitive impairment]], [[Ophthalmoplegia|eye movement problems]], heat sensitivity, [[incoordination]], [[pain]], [[sexual dysfunction]], [[Sleep disorders|sleep disorder]], [[vertigo]], and [[visual loss]].


== History and Symptoms ==
== History and Symptoms  ==
First common symptoms of MS disease are optic neuritis, diplopia, sensory or motor loss, vertigo and balance problems. In young adult eye and sensory problems are prominent while in older patients we see motor problems more often.<ref name="pmid2917275">{{cite journal |vauthors=Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability |journal=Brain |volume=112 ( Pt 1) |issue= |pages=133–46 |date=February 1989 |pmid=2917275 |doi= |url=}}</ref>


=== common symptoms ===
=== History ===
Patients with Multiple sclerosis may have a positive history of:
* [[Smoking (patient information)|Smoking]]<ref name="pmid14581676" /><ref name="pmid11427406">{{cite journal |vauthors=Hernán MA, Olek MJ, Ascherio A |title=Cigarette smoking and incidence of multiple sclerosis |journal=Am. J. Epidemiol. |volume=154 |issue=1 |pages=69–74 |date=July 2001 |pmid=11427406 |doi= |url=}}</ref>


==== fatigue: ====
* A family member with [[MS]] disease <ref name="pmid8800940">{{cite journal |vauthors=Robertson NP, Fraser M, Deans J, Clayton D, Walker N, Compston DA |title=Age-adjusted recurrence risks for relatives of patients with multiple sclerosis |journal=Brain |volume=119 ( Pt 2) |issue= |pages=449–55 |date=April 1996 |pmid=8800940 |doi= |url=}}</ref><ref name="pmid3376997">{{cite journal |vauthors=Sadovnick AD, Baird PA, Ward RH |title=Multiple sclerosis: updated risks for relatives |journal=Am. J. Med. Genet. |volume=29 |issue=3 |pages=533–41 |date=March 1988 |pmid=3376997 |doi=10.1002/ajmg.1320290310 |url=}}</ref>
[[Fatigue]] is seen in almost 80% of [[MS]] patient. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.<ref name="pmid25700869">{{cite journal |vauthors=Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P |title=Sleep disorders in patients with multiple sclerosis |journal=J Clin Sleep Med |volume=11 |issue=5 |pages=553–7 |date=April 2015 |pmid=25700869 |pmc=4410929 |doi=10.5664/jcsm.4702 |url=}}</ref> The [[etiology]] of this symptom is poorly understood.<ref name="pmid16900749">{{cite journal |vauthors=Krupp L |title=Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease |journal=Mult. Scler. |volume=12 |issue=4 |pages=367–8 |date=August 2006 |pmid=16900749 |doi=10.1191/135248506ms1373ed |url=}}</ref>  


==== mood problems: ====
* [[Women|Female gender]]<ref name="pmid17052660">{{cite journal |vauthors=Orton SM, Herrera BM, Yee IM, Valdar W, Ramagopalan SV, Sadovnick AD, Ebers GC |title=Sex ratio of multiple sclerosis in Canada: a longitudinal study |journal=Lancet Neurol |volume=5 |issue=11 |pages=932–6 |date=November 2006 |pmid=17052660 |doi=10.1016/S1474-4422(06)70581-6 |url=}}</ref><ref name="pmid11526384">{{cite journal |vauthors=Whitacre CC |title=Sex differences in autoimmune disease |journal=Nat. Immunol. |volume=2 |issue=9 |pages=777–80 |date=September 2001 |pmid=11526384 |doi=10.1038/ni0901-777 |url=}}</ref>
[[Psychiatric]] disorders especially [[depression]] is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> Some studies show higher risk of [[suicide]] in [[MS]] patient.<ref name="pmid1866003">{{cite journal |vauthors=Sadovnick AD, Eisen K, Ebers GC, Paty DW |title=Cause of death in patients attending multiple sclerosis clinics |journal=Neurology |volume=41 |issue=8 |pages=1193–6 |date=August 1991 |pmid=1866003 |doi= |url=}}</ref><ref name="pmid1449409">{{cite journal |vauthors=Stenager EN, Stenager E |title=Suicide and patients with neurologic diseases. Methodologic problems |journal=Arch. Neurol. |volume=49 |issue=12 |pages=1296–303 |date=December 1992 |pmid=1449409 |doi= |url=}}</ref>


==== Spasticity: ====
* Low [[vitamin D]] level<ref name="pmid12907484">{{cite journal |vauthors=van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T |title=Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study |journal=BMJ |volume=327 |issue=7410 |pages=316 |date=August 2003 |pmid=12907484 |pmc=169645 |doi=10.1136/bmj.327.7410.316 |url=}}</ref><ref name="pmid14718698">{{cite journal |vauthors=Munger KL, Zhang SM, O'Reilly E, Hernán MA, Olek MJ, Willett WC, Ascherio A |title=Vitamin D intake and incidence of multiple sclerosis |journal=Neurology |volume=62 |issue=1 |pages=60–5 |date=January 2004 |pmid=14718698 |doi= |url=}}</ref>
Damage to the descending motor pathways in [[MS]] can increase muscle tone and rigidity in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>


==== Bowel and bladder dysfunction: ====
* [[stress]]<ref name="pmid10371517">{{cite journal |vauthors=Goodin DS, Ebers GC, Johnson KP, Rodriguez M, Sibley WA, Wolinsky JS |title=The relationship of MS to physical trauma and psychological stress: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=52 |issue=9 |pages=1737–45 |date=June 1999 |pmid=10371517 |doi= |url=}}</ref>
[[Bowel]] and [[bladder]] dysfunction is common in [[MS]] patients and accurse in more than 50% of them.<ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref> [[bladder]] dysfunction can be the result of [[Detrusor hyperactivity|Detrusor overactivity]], Detrusor sphincter dyssynergia, Inefficient [[bladder]] [[contractility]] and Abnormal [[sensation]] and [[bladder]] hypoactivity.<ref name="pmid27116728">{{cite journal |vauthors=Wintner A, Kim MM, Bechis SK, Kreydin EI |title=Voiding Dysfunction in Multiple Sclerosis |journal=Semin Neurol |volume=36 |issue=2 |pages=219–20 |date=April 2016 |pmid=27116728 |doi=10.1055/s-0036-1582255 |url=}}</ref> the most common [[bowel]] problems include [[Constipation]], poor [[defecation]] and [[incontinence]].<ref name="pmid10631634">{{cite journal |vauthors=Hennessey A, Robertson NP, Swingler R, Compston DA |title=Urinary, faecal and sexual dysfunction in patients with multiple sclerosis |journal=J. Neurol. |volume=246 |issue=11 |pages=1027–32 |date=November 1999 |pmid=10631634 |doi= |url=}}</ref>


==== Cognitive impairment: ====
* African Americans, Mexicans, Japanese, Chinese and Filipinos ethnic <ref name="pmid573402" />
[[Cognitive disorder|Cognitive disorders]] is common in [[MS]] patients and can even present at early stages of disease. These disorders are in [[attention]], short term memory and information processing. Relapsing-remitting type of [[MS]] seems to have lower [[Cognitive disorder|cognitive problems]].<ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref><ref name="pmid15774439">{{cite journal |vauthors=Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B |title=Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=76 |issue=4 |pages=519–26 |date=April 2005 |pmid=15774439 |pmc=1739602 |doi=10.1136/jnnp.2004.045872 |url=}}</ref><ref name="pmid2027484">{{cite journal |vauthors=Rao SM, Leo GJ, Bernardin L, Unverzagt F |title=Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction |journal=Neurology |volume=41 |issue=5 |pages=685–91 |date=May 1991 |pmid=2027484 |doi= |url=}}</ref><ref name="pmid15277630">{{cite journal |vauthors=Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH |title=Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS |journal=Neurology |volume=63 |issue=2 |pages=335–9 |date=July 2004 |pmid=15277630 |doi= |url=}}</ref>


==== Eye movement abnormalities: ====
* high titer of [[Epstein Barr virus|EBV]] [[Antibody|antibodies]]<ref name="pmid15210894" /><ref name="pmid15914750">{{cite journal |vauthors=Levin LI, Munger KL, Rubertone MV, Peck CA, Lennette ET, Spiegelman D, Ascherio A |title=Temporal relationship between elevation of epstein-barr virus antibody titers and initial onset of neurological symptoms in multiple sclerosis |journal=JAMA |volume=293 |issue=20 |pages=2496–500 |date=May 2005 |pmid=15914750 |doi=10.1001/jama.293.20.2496 |url=}}</ref>
From more to less common, eye movement problems include abnormalities of voluntary gaze, nystagmus, abnormalities of slow phase eye movements, paroxysmal disorders of eye movements and isolated ocular motor nerve palsies. These can lead to oscillopsia or diplopia.<ref name="pmid15664543">{{cite journal |vauthors=Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S |title=The neuro-ophthalmology of multiple sclerosis |journal=Lancet Neurol |volume=4 |issue=2 |pages=111–21 |date=February 2005 |pmid=15664543 |doi=10.1016/S1474-4422(05)00992-0 |url=}}</ref>


==== Heat sensitivity: ====
NOTE: [[McDonald criteria]] for a [[MS]] attack is a [[symptom]] cause by [[Demyelination|demyelinating]] event in the[[CNS]], lasting more than 24 hours. There should be no [[fever]] or [[Sign (medicine)|sign]] of [[infection]].<ref name="pmid21387374">{{cite journal |vauthors=Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS |title=Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria |journal=Ann. Neurol. |volume=69 |issue=2 |pages=292–302 |date=February 2011 |pmid=21387374 |pmc=3084507 |doi=10.1002/ana.22366 |url=}}</ref> First common [[Symptom|symptoms]] of MS disease are [[optic neuritis]], [[diplopia]], [[Sensory loss|sensory]] or [[Muscle weakness|motor loss]], [[vertigo]], and [[Balance disorder|balance]] problems. In young adult [[eye]] and [[sensory]] problems are prominent while in older patients we see [[Motor skill|motor]] problems more often.<ref name="pmid2917275">{{cite journal |vauthors=Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC |title=The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability |journal=Brain |volume=112 ( Pt 1) |issue= |pages=133–46 |date=February 1989 |pmid=2917275 |doi= |url=}}</ref>
Patients with [[MS]] disease are more sensitive to heat. A slight increase in [[body temperature]] of these patients will lead to worsening of their [[Sign (medicine)|sign]]<nowiki/>s and [[symptom]]<nowiki/>s.<ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref>


==== Motor symptoms: ====
=== Common Symptoms ===
Paraparesis or paraplegia can occur in MS because of lesions in motor tracts. Deep tendon reflexes are higher than normal but can be decrease due to reflex arc problems. In advanced stages of MS, Lesions of brain stem can cause symptoms like dysphagia and dysarthria .
The most common [[symptoms]] of multiple sclerosis include:
* Fatigue: [[Fatigue]] is seen in almost 80% of [[MS]] patients. They commonly feel exhausted and out of [[energy]]. We can see [[fatigue]] exacerbation before acute attacks in MS and for a while after that.<ref name="pmid25700869">{{cite journal |vauthors=Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P |title=Sleep disorders in patients with multiple sclerosis |journal=J Clin Sleep Med |volume=11 |issue=5 |pages=553–7 |date=April 2015 |pmid=25700869 |pmc=4410929 |doi=10.5664/jcsm.4702 |url=}}</ref> The [[etiology]] of this [[symptom]] is poorly understood.<ref name="pmid16900749">{{cite journal |vauthors=Krupp L |title=Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease |journal=Mult. Scler. |volume=12 |issue=4 |pages=367–8 |date=August 2006 |pmid=16900749 |doi=10.1191/135248506ms1373ed |url=}}</ref>


==== Incoordination: ====
* Mood problems: [[Psychiatric]] disorders, especially [[depression]], is common and can be seen in almost 50% of [[MS]] patients.<ref name="pmid8618657">{{cite journal |vauthors=Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW |title=Depression and multiple sclerosis |journal=Neurology |volume=46 |issue=3 |pages=628–32 |date=March 1996 |pmid=8618657 |doi= |url=}}</ref> Some studies show higher risk of [[suicide]] in [[MS]] patients.<ref name="pmid1866003">{{cite journal |vauthors=Sadovnick AD, Eisen K, Ebers GC, Paty DW |title=Cause of death in patients attending multiple sclerosis clinics |journal=Neurology |volume=41 |issue=8 |pages=1193–6 |date=August 1991 |pmid=1866003 |doi= |url=}}</ref><ref name="pmid1449409">{{cite journal |vauthors=Stenager EN, Stenager E |title=Suicide and patients with neurologic diseases. Methodologic problems |journal=Arch. Neurol. |volume=49 |issue=12 |pages=1296–303 |date=December 1992 |pmid=1449409 |doi= |url=}}</ref>
involvement of cerebellar tracts can cause  Problems in Gait and balance, poor coordinated actions and slurred speech. Intention tremor is present in most of these patients. 


* [[Spasticity]]: Damage to the [[upper motor neurons]] and decrease inhibition of [[lower motor neurons]] in [[MS]] can increase [[muscle tone]] and [[Muscle rigidity|rigidity]] in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>
* Bowel and bladder dysfunction: [[Bowel]] and [[bladder]] dysfunction is common in [[MS]] patients and occurs in more than 50% of patients.<ref name="pmid12515563">{{cite journal |vauthors=DasGupta R, Fowler CJ |title=Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies |journal=Drugs |volume=63 |issue=2 |pages=153–66 |date=2003 |pmid=12515563 |doi= |url=}}</ref> [[Bladder]] dysfunction can be the result of [[Detrusor hyperactivity|Detrusor overactivity]], [[Detrusor]] sphincter dyssynergia, Inefficient [[bladder]] [[contractility]] and Abnormal [[sensation]] and [[bladder]] hypoactivity.<ref name="pmid27116728">{{cite journal |vauthors=Wintner A, Kim MM, Bechis SK, Kreydin EI |title=Voiding Dysfunction in Multiple Sclerosis |journal=Semin Neurol |volume=36 |issue=2 |pages=219–20 |date=April 2016 |pmid=27116728 |doi=10.1055/s-0036-1582255 |url=}}</ref> the most common [[bowel]] problems include [[Constipation]], poor [[defecation]] and [[incontinence]].<ref name="pmid10631634">{{cite journal |vauthors=Hennessey A, Robertson NP, Swingler R, Compston DA |title=Urinary, faecal and sexual dysfunction in patients with multiple sclerosis |journal=J. Neurol. |volume=246 |issue=11 |pages=1027–32 |date=November 1999 |pmid=10631634 |doi= |url=}}</ref>
* Eye movement abnormalities: From more to less common, eye movement problems include [[Gaze palsy|abnormalities of voluntary gaze]], [[nystagmus]], abnormalities of slow phase [[Eye movement|eye movements]], paroxysmal disorders of [[eye movements]], and isolated ocular motor nerve palsies. These can lead to [[oscillopsia]] or [[diplopia]].<ref name="pmid15664543">{{cite journal |vauthors=Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S |title=The neuro-ophthalmology of multiple sclerosis |journal=Lancet Neurol |volume=4 |issue=2 |pages=111–21 |date=February 2005 |pmid=15664543 |doi=10.1016/S1474-4422(05)00992-0 |url=}}</ref>
* Incoordination: Involvement of [[cerebellar]] tracts can cause problems in [[Gait]] and balance,l poor coordinated actions, and [[slurred speech]]. [[Intention tremor]] is present in most of these patients.<ref name="pmid25573524">{{cite journal |vauthors=Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR |title=Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey |journal=BMJ Open |volume=5 |issue=1 |pages=e006714 |date=January 2015 |pmid=25573524 |pmc=4289717 |doi=10.1136/bmjopen-2014-006714 |url=}}</ref>
* Pain: [[Pain]], a very common [[symptom]] in [[MS]] patients, can be either from [[neurogenic]] source leading to burning or ice-cold [[dysesthesias]] or from long immobilization and [[spasm]].<ref name="pmid26087108">{{cite journal |vauthors=Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T |title=The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey |journal=Pain Med |volume=16 |issue=8 |pages=1597–602 |date=August 2015 |pmid=26087108 |doi=10.1111/pme.12731 |url=}}</ref><ref name="pmid23318126">{{cite journal |vauthors=Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT |title=Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis |journal=Pain |volume=154 |issue=5 |pages=632–42 |date=May 2013 |pmid=23318126 |doi=10.1016/j.pain.2012.12.002 |url=}}</ref>
* Sexual dysfunction: [[Sexual dysfunction]] can be due to involvement of [[Motor disorders|motor]] and [[Sensory system|sensory]] pathways or from [[psychological]] problems but either way, it’s a very common [[symptom]]. In women we can see reduced [[libido]] and [[orgasm]], [[dyspareunia]] and decrease [[vaginal]] sensation. Presentations of [[sexual dysfunction]] in [[men]] are decreased [[libido]] and [[premature ejaculation]], [[erectile dysfunction]], and reduced [[Penis|penile]] sensation.<ref name="pmid26003254">{{cite journal |vauthors=Lew-Starowicz M, Gianotten WL |title=Sexual dysfunction in patients with multiple sclerosis |journal=Handb Clin Neurol |volume=130 |issue= |pages=357–70 |date=2015 |pmid=26003254 |doi=10.1016/B978-0-444-63247-0.00020-1 |url=}}</ref><ref name="pmid10618700">{{cite journal |vauthors=Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G |title=Sexual dysfunction in multiple sclerosis: II. Correlation analysis |journal=Mult. Scler. |volume=5 |issue=6 |pages=428–31 |date=December 1999 |pmid=10618700 |doi=10.1177/135245859900500i610 |url=}}</ref>
* Sleep disorders: Many patients with multiple sclerosis suffer from [[sleep disorders]] and daytime [[somnolence]]. This can be the result of so many conditions including [[restless leg syndrome]], [[nocturia]], [[pain]] and medication side effects. Having more cervical lesions lead to experiencing [[restless leg syndrome]] more often.<ref name="pmid17942519">{{cite journal |vauthors=Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M |title=Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage |journal=Mult. Scler. |volume=14 |issue=1 |pages=86–93 |date=January 2008 |pmid=17942519 |doi=10.1177/1352458507080734 |url=}}</ref><ref name="pmid8787103">{{cite journal |vauthors=Amarenco G, Kerdraon J, Denys P |title=[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases] |language=French |journal=Rev. Neurol. (Paris) |volume=151 |issue=12 |pages=722–30 |date=December 1995 |pmid=8787103 |doi= |url=}}</ref><ref name="pmid23078359">{{cite journal |vauthors=Schürks M, Bussfeld P |title=Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis |journal=Eur. J. Neurol. |volume=20 |issue=4 |pages=605–15 |date=April 2013 |pmid=23078359 |doi=10.1111/j.1468-1331.2012.03873.x |url=}}</ref>
* Visual loss: [[Optic neuritis]] is the most common eye involvement and presents as an [[acute]] unilateral eye [[pain]], followed by some degree of [[vision loss]].<ref name="pmid16554529">{{cite journal |vauthors=Balcer LJ |title=Clinical practice. Optic neuritis |journal=N. Engl. J. Med. |volume=354 |issue=12 |pages=1273–80 |date=March 2006 |pmid=16554529 |doi=10.1056/NEJMcp053247 |url=}}</ref>
=== Less Common Symptoms ===
* Heat sensitivity: Patients with [[MS]] disease are more sensitive to heat. A slight increase in [[body temperature]] of these patients will lead to worsening of their [[Sign (medicine)|sign]]<nowiki/>s and [[symptoms]]<nowiki/>s.<ref name="pmid7550931">{{cite journal |vauthors=Selhorst JB, Saul RF |title=Uhthoff and his symptom |journal=J Neuroophthalmol |volume=15 |issue=2 |pages=63–9 |date=June 1995 |pmid=7550931 |doi= |url=}}</ref>
* Cognitive impairment: [[Cognitive disorder|Cognitive disorders]] is common in [[MS]] patients and can even present at early stages of disease. These disorders are in [[attention]], short term [[memory]], and information processing. Relapsing-remitting type of [[MS]] seems to have lower [[Cognitive disorder|cognitive problems]].<ref name="pmid12640060">{{cite journal |vauthors=Achiron A, Barak Y |title=Cognitive impairment in probable multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=74 |issue=4 |pages=443–6 |date=April 2003 |pmid=12640060 |pmc=1738365 |doi= |url=}}</ref><ref name="pmid15774439">{{cite journal |vauthors=Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B |title=Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis |journal=J. Neurol. Neurosurg. Psychiatry |volume=76 |issue=4 |pages=519–26 |date=April 2005 |pmid=15774439 |pmc=1739602 |doi=10.1136/jnnp.2004.045872 |url=}}</ref><ref name="pmid2027484">{{cite journal |vauthors=Rao SM, Leo GJ, Bernardin L, Unverzagt F |title=Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction |journal=Neurology |volume=41 |issue=5 |pages=685–91 |date=May 1991 |pmid=2027484 |doi= |url=}}</ref><ref name="pmid15277630">{{cite journal |vauthors=Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH |title=Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS |journal=Neurology |volume=63 |issue=2 |pages=335–9 |date=July 2004 |pmid=15277630 |doi= |url=}}</ref>
* Vertigo: Benign positional paroxysmal [[vertigo]] is the most common cause of [[vertigo]] in [[MS]] patients. In the course of the disease, about 30-50% of patients experience this [[symptom]].<ref name="pmid11094117">{{cite journal |vauthors=Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC |title=Vertigo in MS: utility of positional and particle repositioning maneuvers |journal=Neurology |volume=55 |issue=10 |pages=1566–9 |date=November 2000 |pmid=11094117 |doi= |url=}}</ref>
[[File:Symptoms of multiple sclerosis.svg.png|500px|none|thumb|https://en.wikipedia.org/wiki/File:Symptoms_of_multiple_sclerosis.svg]]
==References==
==References==
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[[Category:Primary care]]
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[[Category:Neurology]]
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{{WH}}
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Latest revision as of 22:47, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

The most common symptoms of multiple sclerosis include: Fatigue, mood problems, spasticity, bowel, bladder dysfunction, cognitive impairment, eye movement problems, heat sensitivity, incoordination, pain, sexual dysfunction, sleep disorder, vertigo, and visual loss.

History and Symptoms 

History

Patients with Multiple sclerosis may have a positive history of:

  • African Americans, Mexicans, Japanese, Chinese and Filipinos ethnic [10]

NOTE: McDonald criteria for a MS attack is a symptom cause by demyelinating event in theCNS, lasting more than 24 hours. There should be no fever or sign of infection.[13] First common symptoms of MS disease are optic neuritis, diplopia, sensory or motor loss, vertigo, and balance problems. In young adult eye and sensory problems are prominent while in older patients we see motor problems more often.[14]

Common Symptoms

The most common symptoms of multiple sclerosis include:

  • Fatigue: Fatigue is seen in almost 80% of MS patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.[15] The etiology of this symptom is poorly understood.[16]

Less Common Symptoms

  • Heat sensitivity: Patients with MS disease are more sensitive to heat. A slight increase in body temperature of these patients will lead to worsening of their signs and symptomss.[34]
  • Vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in MS patients. In the course of the disease, about 30-50% of patients experience this symptom.[39]
https://en.wikipedia.org/wiki/File:Symptoms_of_multiple_sclerosis.svg

References

  1. ↑
  2. ↑ Hernán MA, Olek MJ, Ascherio A (July 2001). "Cigarette smoking and incidence of multiple sclerosis". Am. J. Epidemiol. 154 (1): 69–74. PMID 11427406.
  3. ↑ Robertson NP, Fraser M, Deans J, Clayton D, Walker N, Compston DA (April 1996). "Age-adjusted recurrence risks for relatives of patients with multiple sclerosis". Brain. 119 ( Pt 2): 449–55. PMID 8800940.
  4. ↑ Sadovnick AD, Baird PA, Ward RH (March 1988). "Multiple sclerosis: updated risks for relatives". Am. J. Med. Genet. 29 (3): 533–41. doi:10.1002/ajmg.1320290310. PMID 3376997.
  5. ↑ Orton SM, Herrera BM, Yee IM, Valdar W, Ramagopalan SV, Sadovnick AD, Ebers GC (November 2006). "Sex ratio of multiple sclerosis in Canada: a longitudinal study". Lancet Neurol. 5 (11): 932–6. doi:10.1016/S1474-4422(06)70581-6. PMID 17052660.
  6. ↑ Whitacre CC (September 2001). "Sex differences in autoimmune disease". Nat. Immunol. 2 (9): 777–80. doi:10.1038/ni0901-777. PMID 11526384.
  7. ↑ van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T (August 2003). "Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study". BMJ. 327 (7410): 316. doi:10.1136/bmj.327.7410.316. PMC 169645. PMID 12907484.
  8. ↑ Munger KL, Zhang SM, O'Reilly E, Hernán MA, Olek MJ, Willett WC, Ascherio A (January 2004). "Vitamin D intake and incidence of multiple sclerosis". Neurology. 62 (1): 60–5. PMID 14718698.
  9. ↑ Goodin DS, Ebers GC, Johnson KP, Rodriguez M, Sibley WA, Wolinsky JS (June 1999). "The relationship of MS to physical trauma and psychological stress: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology. 52 (9): 1737–45. PMID 10371517.
  10. ↑
  11. ↑
  12. ↑ Levin LI, Munger KL, Rubertone MV, Peck CA, Lennette ET, Spiegelman D, Ascherio A (May 2005). "Temporal relationship between elevation of epstein-barr virus antibody titers and initial onset of neurological symptoms in multiple sclerosis". JAMA. 293 (20): 2496–500. doi:10.1001/jama.293.20.2496. PMID 15914750.
  13. ↑ Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (February 2011). "Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria". Ann. Neurol. 69 (2): 292–302. doi:10.1002/ana.22366. PMC 3084507. PMID 21387374.
  14. ↑ Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
  15. ↑ Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P (April 2015). "Sleep disorders in patients with multiple sclerosis". J Clin Sleep Med. 11 (5): 553–7. doi:10.5664/jcsm.4702. PMC 4410929. PMID 25700869.
  16. ↑ Krupp L (August 2006). "Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease". Mult. Scler. 12 (4): 367–8. doi:10.1191/135248506ms1373ed. PMID 16900749.
  17. ↑ Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW (March 1996). "Depression and multiple sclerosis". Neurology. 46 (3): 628–32. PMID 8618657.
  18. ↑ Sadovnick AD, Eisen K, Ebers GC, Paty DW (August 1991). "Cause of death in patients attending multiple sclerosis clinics". Neurology. 41 (8): 1193–6. PMID 1866003.
  19. ↑ Stenager EN, Stenager E (December 1992). "Suicide and patients with neurologic diseases. Methodologic problems". Arch. Neurol. 49 (12): 1296–303. PMID 1449409.
  20. ↑ Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
  21. ↑ DasGupta R, Fowler CJ (2003). "Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies". Drugs. 63 (2): 153–66. PMID 12515563.
  22. ↑ Wintner A, Kim MM, Bechis SK, Kreydin EI (April 2016). "Voiding Dysfunction in Multiple Sclerosis". Semin Neurol. 36 (2): 219–20. doi:10.1055/s-0036-1582255. PMID 27116728.
  23. ↑ Hennessey A, Robertson NP, Swingler R, Compston DA (November 1999). "Urinary, faecal and sexual dysfunction in patients with multiple sclerosis". J. Neurol. 246 (11): 1027–32. PMID 10631634.
  24. ↑ Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S (February 2005). "The neuro-ophthalmology of multiple sclerosis". Lancet Neurol. 4 (2): 111–21. doi:10.1016/S1474-4422(05)00992-0. PMID 15664543.
  25. ↑ Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
  26. ↑ Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T (August 2015). "The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey". Pain Med. 16 (8): 1597–602. doi:10.1111/pme.12731. PMID 26087108.
  27. ↑ Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (May 2013). "Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis". Pain. 154 (5): 632–42. doi:10.1016/j.pain.2012.12.002. PMID 23318126.
  28. ↑ Lew-Starowicz M, Gianotten WL (2015). "Sexual dysfunction in patients with multiple sclerosis". Handb Clin Neurol. 130: 357–70. doi:10.1016/B978-0-444-63247-0.00020-1. PMID 26003254.
  29. ↑ Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G (December 1999). "Sexual dysfunction in multiple sclerosis: II. Correlation analysis". Mult. Scler. 5 (6): 428–31. doi:10.1177/135245859900500i610. PMID 10618700.
  30. ↑ Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M (January 2008). "Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage". Mult. Scler. 14 (1): 86–93. doi:10.1177/1352458507080734. PMID 17942519.
  31. ↑ Amarenco G, Kerdraon J, Denys P (December 1995). "[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]". Rev. Neurol. (Paris) (in French). 151 (12): 722–30. PMID 8787103.
  32. ↑ Schürks M, Bussfeld P (April 2013). "Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis". Eur. J. Neurol. 20 (4): 605–15. doi:10.1111/j.1468-1331.2012.03873.x. PMID 23078359.
  33. ↑ Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
  34. ↑ Selhorst JB, Saul RF (June 1995). "Uhthoff and his symptom". J Neuroophthalmol. 15 (2): 63–9. PMID 7550931.
  35. ↑ Achiron A, Barak Y (April 2003). "Cognitive impairment in probable multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 74 (4): 443–6. PMC 1738365. PMID 12640060.
  36. ↑ Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B (April 2005). "Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 76 (4): 519–26. doi:10.1136/jnnp.2004.045872. PMC 1739602. PMID 15774439.
  37. ↑ Rao SM, Leo GJ, Bernardin L, Unverzagt F (May 1991). "Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction". Neurology. 41 (5): 685–91. PMID 2027484.
  38. ↑ Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH (July 2004). "Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS". Neurology. 63 (2): 335–9. PMID 15277630.
  39. ↑ Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC (November 2000). "Vertigo in MS: utility of positional and particle repositioning maneuvers". Neurology. 55 (10): 1566–9. PMID 11094117.

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