Early Multiple Sclerosis (MS) Warning Signs and Symptoms

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

What is multiple sclerosis (MS)?

  • Multiple sclerosis (MS) is an autoimmune inflammatory disease that attacks myelinated axons in the brain and spinal cord (central nervous system), damaging or destroying the myelin and/or the axons (nerve tissue). Sclerosis means abnormal hardening or thickening of tissue, often due to inflammation.
  • MS often progresses slowly over many years (about 25 years).
  • Multiple sclerosis is most commonly diagnosed in females ages 20 to 40 but may occur at any age and both genders.
  • Usually, multiple sclerosis in children and teens (pediatric MS) goes undiagnosed; however, about 8,000 to 10,000 children and teens in the US have been diagnosed with the disease.
  • Symptoms of multiple sclerosis in children, teens; and adults are similar, for example:
  • Other symptoms and signs of MS in children and teens include seizures and/or mental status changes like lethargy.
  • People with MS often suffer intermittent attacks followed by periods of symptom remissions.
  • MS Attacks can last for days or months at a time followed by remissions; some individuals however, may continue to get worse without periods of remission

At what age does multiple sclerosis start?

The early signs and symptoms of multiple sclerosis usually begin between the ages of 20 and 40 years old. However, it is possible to have MS begin in childhood (termed pediatric MS, which includes infancy to 18) or over 40 years of age, but it occurs less frequently in these age groups. Only about 2% to 5% of all people diagnosed with MS have symptoms before age 18. Multiple sclerosis in children and teens is difficult to diagnose, so its true frequency of occurrence is only estimated.

Does multiple sclerosis cause pain?

About two thirds of people with MS report pain as symptom of their disease. The most common types of pain experience by people with MS are headache, back pain, extremity pain, and muscle spasms. Because the pain comes from the nerves, common pain medicines like aspirin have little or no effect; however, other medications may be effective.

Picture of Multiple Sclerosis (MS)

Is MS Contagious? How Do You Get MS?

Scientists and researchers don't know the exact cause of multiple sclerosis, but isn't spread from person-to-person. There are a variety of unproven theories that MS is caused by:

  • Genetic factors
  • Vitamin D deficiency
  • Epstein-Barr virus
  • Black mold
  • Too much salt intake

5 early signs and symptoms of multiple sclerosis

Because the autoimmune inflammatory may attack some of the myelinated axons in the central nervous system almost anywhere, the location (and severity) of each attack can be different. Consequently, the symptoms of a MS attack may be quite variable from patient to patient and can appear almost anywhere in the body. The usual first sign and symptom is often a change in sensory perception (paresthesias) almost anywhere in the body. Other early common symptoms include:

  1. Fatigue
  2. Weakness
  3. Tingling
  4. Blurred vision
  5. Pain (muscular and neurologic)

Because of the highly variable symptoms this is a disease that is difficult to diagnose when symptoms first appear. The rest of the article will present symptoms that arise from various parts of the body that can be due to MS. Unfortunately, many of the symptoms described can occur in other disease processes so it is important to have a diagnosis of MS in part by ruling out other conditions.

The diagnosis of MS usually involves a neurologist that will take your medical history, do blood tests, tests to measure electrical activity in the brain and other areas, an MRI and an analysis of spinal fluid. Tests may be done to distinguish MS from stroke, thyroid - caused illness or other debilitating diseases that cause similar symptoms to MS.

Sexual problems

  • Decreased vaginal lubrication in women
  • Problems with erections in men (erectile dysfunction, impotence)

Bladder and bowel problems

Speech and swallowing problems

  • Slurred speech
  • Difficulty speaking
  • Difficulty with chewing and swallowing foods (dysphasia)

Balance, thinking, and emotional problems

Vision problems

Muscle, movement, and spasticity problems

  • Abnormal sensation in any area of the muscles
  • Difficulty moving arms or legs
  • Difficulty walking (gait problems)
  • Problems with coordination and fine motor skills (rheumatoid symptoms)
  • Weakness in one or more extremity (similar to stroke symptoms)

Numbness, tingling, and pain

  • Tingling, burning or feelings of crawling movement in the arms and legs
  • Painful muscle spasms
  • Facial pain
  • Facial muscle twitching
  • Facial weakness

As previously mentioned, individuals with MS have variable symptoms so symptoms described above are generalized symptoms; it is likely that a person with multiple sclerosis may show initial symptoms in one or two of these major categories in the early development of MS; other symptoms may or may not appear later in the disease process. However, MS is a slowly progressive disease for which there is no known cure. The goal of treatment is to reduce and/or control symptoms.

What are the treatment guidelines for MS symptoms?

Multiple sclerosis is a slowly progressive disease for which there is no known cure. The goal of treatment is to reduce and/or control symptoms. Treatment of multiple sclerosis has two major areas that are used to reduce and/or control symptoms. The first area for controlling symptoms is to treat the underlying immune disorder of MS; the second area is designed to reduce and/or treat MS symptoms and relapses. Primary caregivers usually seek medical advice from neurologists for treatment protocols.

List of first line drugs to treat MS symptoms

Although the underlying or triggering mechanism for MS and for MS relapses is unknown, several drugs have been shown to have beneficial effects in people with MS symptoms including reducing the frequency and severity of clinical MS attacks. These drugs act on the immune system by modulating its response and such agents have been approved for use for treatment. These agents are as follows:

These drugs often have side effects and are usually prescribed by physicians experienced in treating people with MS. Plasmapheresis (a method to remove autoantibodies from the blood) is another technique used to reduce the autoimmune problems in certain people with MS.

FDA recently approved the drug ocrelizumab (Ocrevus) to treat adult patients medically that have relapsing forms of MS and for MS type, primary progressive multiple sclerosis (PPMS). This is the first drug the FDA approved for PPMS and is administered by intravenous infusion.

Multiple sclerosis in children and teens is treated based on best treatment protocol for the specific child.


Multiple Sclerosis (MS) Symptoms and Treatment See Slideshow

List of drugs to manage symptoms of pain, fatigue, and sexual problems

Treatments of symptoms produced in people with MS depend entirely upon individual's problems that are generated by MS. In general, treatments of symptoms often follow the same protocols that most physicians would use to treat other patients that do not have MS. However, listed below are some of the symptoms and treatment methods used to reduce them in people with MS:

Treating MS pain

Managing sexual dysfunction in MS

Managing fatigue in MS

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List of drugs to mange spasticity, vision, urinary, bowel, and emotional symptoms

Treating MS muscle spasms and other problems

Antispasmodics, for example:

Treating MS eye problems

Treating MS bladder and bowel problems

Managing bladder problems includes:

  • Having to schedule voiding
  • Limiting fluid intake in the evening
  • Reducing or stopping diuretics
  • Injecting Botox into the bladder
  • Intermittent catheterization and alpha blockers
Managing bowel problems include:
  • Increase fluid uptake daily
  • Increased dietary fiber
  • Stool softeners
  • Laxatives and bulk former such as Metamucil or similar agents

Managing depression in MS

Antidepressants such as serotonin reuptake inhibitors (SSRIs) or tri cyclic antidepressants
Other problems may require less medication and more understanding of the patient's situation. For example, heat intolerance can be addressed by avoiding activities that would increase the person's temperature such as use of saunas or staying outside in hot temperatures.

Rehabilitation therapy

Rehabilitation therapy may help reduce symptoms of speech, muscle problems associated with swallowing, walking and motor skills. During therapy the patient can be introduced to devices that will help with the tasks of daily living.

Which specialties of doctors treat multiple sclerosis?

Consultation with specialists is often recommended; for example, individuals with cognitive problems may be helped by a neuropsychologist and /or a psychiatrist while those with symptoms related to the bowel or bladder may be best served by consultation with a gastroenterologist or urologist. Individuals with advanced MS with multiple problems may require, in addition to physician specialists, a social worker specialist to manage the intense every-day care required to care for a person with MS. Some patients with debilitating multiple sclerosis symptoms and poor health may require patient to have a live-in caregiver.

Treatment for multiple sclerosis in children and teens is by pediatric specialists with experience in pediatric MS.

For additional information about MS, contact the Multiple Sclerosis Society and/or the MS International Federation.


What kind of disease is multiple sclerosis? See Answer

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Medically Reviewed on 3/22/2018

FDA News Release. "FDA aprpoves new drug to treat multiple sclerosis." March 29, 2017.

Luzzio, C. "Multiple Sclerosis Clinical Presentation." Medscape. Aug. 29, 2018.<http://emedicine.medscape.com/article/1146199-clinical>.

MS International Federation. "Pain." Updated Nov 10, 2016.

National MS Society. Pediatric MS.