Multiple Sclerosis: Early Signs, Numbness, Vision Changes and Next Steps

What it involves

MedlinePlus explains that multiple sclerosis, or MS, is an autoimmune disease that affects the brain and spinal cord. Damage to the myelin sheath, the protective covering of nerves, slows or stops nerve signals. The cause is unknown. MS affects women more often than men and is most commonly diagnosed between ages 20 and 40, though it can appear at any age.

Who this is for

• Adults with numbness, tingling or weakness in an arm, leg or side of the face that has lasted days.
• Patients with vision loss, double vision or pain behind the eye in one eye.
• People whose symptoms come and go, clearing and then returning weeks or months later.
• Adults with balance trouble, bladder changes and unusual fatigue that have no clear cause.

What to expect

• A detailed timeline of each episode, how long it lasted, and whether it fully cleared
• A nervous system exam that checks strength, reflexes, sensation, coordination, walking and eye movements
• Blood work for conditions that mimic MS, such as vitamin deficiency and thyroid problems
• A referral to a neurologist for MRI of the brain and spine and any further testing

Symptoms depend on where the damage is

MedlinePlus says nerves in any part of the brain or spinal cord may be damaged, so symptoms can appear in many parts of the body. Muscle symptoms include loss of balance, spasms, numbness, trouble walking and weakness. Eye symptoms include double vision, uncontrollable eye movements and vision loss that usually affects one eye at a time. Others include slurred speech, trouble swallowing, memory loss and depression. The numbness and tingling guide and vertigo guide explain two common starting points.

Attacks, remissions and triggers

MedlinePlus says attacks can last for days, weeks or months and are followed by remissions, periods of reduced or no symptoms. Fever, hot baths, sun exposure and stress can trigger or worsen attacks. Fatigue is a common and bothersome symptom, often worse in the late afternoon. Because the pattern matters so much, keeping a dated note of each episode helps. The fatigue guide explains the many other reasons for tiredness a provider also considers.

Bladder, bowel and other body changes

MedlinePlus lists constipation, difficulty beginning to urinate, a frequent or strong urge to urinate, and urine leakage among bowel and bladder symptoms, and also notes problems with erections. These are common complaints with many causes, and a primary care provider can look for the simpler ones first. The urinary incontinence guide describes that work-up, and the erectile dysfunction guide covers the sexual side. Mention all of them at the visit even if they seem unrelated.

How MS is diagnosed

MedlinePlus says MS is diagnosed by finding signs of more than one attack on the brain or spinal cord and by checking for other conditions. A relapsing-remitting form has at least two attacks separated by a remission. Tests include blood tests to check for similar conditions, an MRI of the brain, spine or both, a lumbar puncture, and sometimes nerve function studies. Serenity By A Dr. Sareen lists blood work among its services, and MRI and neurological testing are arranged by referral.

Treatment and what the outlook looks like

There is no known cure, but MedlinePlus says treatments can slow the disease, with the goal of stopping progression, controlling symptoms and maintaining a normal quality of life. Medicines are often taken long term, and steroids may reduce the severity of attacks. MedlinePlus adds that life expectancy can be normal or almost normal, that most people with MS stay active at work with little disability, and that the outcome is hard to predict. Physical and occupational therapy help many people.

Other causes a provider rules out first

Numbness and fatigue can come from low vitamin levels, thyroid disease, diabetes, a pinched nerve or a migraine, and visual changes have their own causes. The blurry vision guide and stroke warning signs guide explain symptoms that need urgent attention, such as sudden facial droop, sudden weakness on one side or sudden vision loss. Call 911 for those. For slower changes, a primary care visit is a sensible first step toward answers. Double vision and weakness that come and go can also have a muscle-and-nerve cause other than MS, and the myasthenia gravis guide explains how that autoimmune condition is recognized. Multiple sclerosis is one of the known causes of brief, stabbing facial pain, and the trigeminal neuralgia guide explains how that pain is recognized and which specialists treat it.

Sources

• MedlinePlus: Multiple Sclerosis (health topic)
• MedlinePlus: Multiple sclerosis (medical encyclopedia)