With multiple sclerosis (MS), a chronic, immune-mediated disease affecting the central nervous system, symptoms can vary significantly from one person to the next and may be wide-ranging, according to Amy Laitinen, M.D., a neurologist and director of multiple sclerosis and neuroimmunology at Marcus Neuroscience Institute, part of Baptist Health South Florida in Boca Raton.
That can make it challenging to identify MS early or know when the disease is progressing, she says. For example, common early symptoms of multiple sclerosis like fatigue, anxiety, or short-term memory struggles might be chalked up to stress or sleep difficulties. For older adults, symptoms like bladder dysfunction, muscle weakness, or impaired balance could be mistaken for the natural effects of aging.
Understanding the breadth of potential symptoms can help you identify when MS might be a possibility, or if your condition is getting worse, so you can start treatment that helps slow progression.
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What Are the Most Common Multiple Sclerosis Symptoms?
Because of its effect on the central nervous system, MS can affect almost any system in the body. Take a look at the systems involved in multiple sclerosis, along with symptoms that are seen most often.
| System | Common Symptoms |
|---|---|
| Motion | Unsteady walking, foot drop, weakness, spasticity, poor coordination |
| Vision | Blurred vision, double vision, optic neuritis |
| Cognition | Brain fog, memory or concentration problems |
| Emotion | Depression, anxiety, mood changes |
| Sensation | Numbness, tingling, burning, electric-shock sensations |
| General | Fatigue, pain, heat sensitivity |
How Multiple Sclerosis Affects Walking and Mobility
The inflammation involved with MS can attack the entire pathway of nerves that control muscle movement, says Misbah Azeem, M.D., a neurologist who specializes in treating multiple sclerosis at National Jewish Health in Denver, CO. This can play a significant role in walking and mobility, as well as coordination and balance. Some specific indications that multiple sclerosis could be present include:
- Coordination issues. You may experience this as trouble maintaining stability, unsteady movements, vertigo, and dizziness.
- Foot drop. This involves weakness in the muscles that lift the front part of the foot, causing toes to drag on the ground while walking.
- Leg weakness. You may feel like your legs are heavy and hard to maneuver or lift, particularly when going up steps.
- Overwhelming fatigue. Extreme tiredness leads to slower walking speeds and higher risk of falls.
- Sensory deficits. You may experience numbness, altered sensation in the feet, and difficulty with perception of how you’re moving (called proprioception).
- Spasticity and muscle spasms. This happens most commonly in the calves and hamstrings and makes movement more difficult.
Other symptoms of MS that could be affecting mobility include vision problems, pain, and heat sensitivity—all of these can make movement more challenging, Dr. Azeem says, and contribute to the reason up to 80% of people with multiple sclerosis have trouble walking.
How Mobility Aids Can Help With MS Symptoms
Mobility aids can help people with MS manage symptoms that affect walking, balance, coordination, and strength. Devices such as canes, walkers, and wheelchairs provide support, improve stability, and reduce risk of falls. They can also help conserve energy, which is a crucial part of participating in daily activities without becoming fatigued, says Dr. Laitinen.
Mobility aids can also reduce worry about falling or navigating through both familiar and unfamiliar environments. That helps people with MS feel more confident and independent, particularly because these aids allow them to do more for themselves while lowering anxiety about coordination and balance.
To make the most of mobility aids, consider consulting with a physical or occupational therapist, Dr. Laitinen suggests. These professionals can recommend appropriate devices and assess individual needs. They can also work with someone who has MS to ensure that their mobility aid is improving safety, conserving energy, and supporting a more active lifestyle.
Vision Problems and Multiple Sclerosis
Vision changes are among the symptoms that frequently affect someone with MS first, says Dr. Azeem. “Difficulty with vision is one of the most common complaints in people with MS,” he says. “That’s because inflammation of the nerve connecting the eye to the brain can cause disruption in vision or injury to the brainstem can lead to weakness in the eye, which may cause double vision.”
Another factor may be lesions in the area of the brain that controls coordination, which might prompt uncontrolled, repetitive movement in the eyes.
“MS can sometimes cause optic neuritis, a condition where the optic nerve becomes inflamed,” adds Dr. Laitinen. “In normal vision, images are received by the retina, then transmitted through the optic nerve to be processed by the brain. When there is inflammation or injury to the optic nerve, the pathway for the flow of visual stimuli is interrupted, leading to blurry vision, areas of missing vision, or pain with eye movement.”
Cognitive and Emotional Symptoms of MS
Issues related to emotional health and cognitive functioning are common with multiple sclerosis and can appear early in the disease, says Dr. Azeem. “Numerous studies have shown an increased prevalence of depression and anxiety in those with MS compared to people without the disease,” he adds. “This is a significant factor when it comes to quality of life.”
Part of the connection is simply that dealing with a chronic and unpredictable disorder can cause distress. Secondly, according to the National Multiple Sclerosis Society, the type of nerve damage caused by MS can affect parts of the brain related to emotional regulation. And finally, some of the medications used to treat multiple sclerosis may have depression, irritability, anxiety, and moodiness as a side effect.
Multiple sclerosis is also known to prompt a faster rate of brain atrophy—when the brain physically shrinks in size—compared to those without the disease, according to Dr. Azeem. “This makes cognitive symptoms a very common occurrence,” he says. “The most typical ones are slower thought processing speed, difficulty with attention, and a harder time finding the right words.”
Still, not every person with MS experiences cognitive and emotional symptoms, says Dr. Laitinen, and sometimes these symptoms occur but are unrelated to MS. For example, depression and anxiety can sometimes precede a diagnosis of multiple sclerosis rather than be caused by it.
Bladder, Bowel, and Sexual Symptoms
Damage to the brain and spinal cord with MS can interrupt nerve signals to the pelvic organs, which may lead to issues with bladder, bowel, and sexual function.
Although it’s possible to have only one of these affected, many people with multiple sclerosis struggle with dysfunction in all three areas. Research in Multiple Sclerosis and Related Disorders notes that over 43% of people with MS reported concurrent bladder, bowel, and sexual symptoms, including:
- Constipation or diarrhea
- Decreased genital sensation
- Difficulty emptying the bladder completely
- Erectile dysfunction
- Frequent urination
- Loss of bladder or bowel control
- Reduced libido
- Urinary or bowel urgency
- Vaginal dryness
Other MS symptoms such as muscle stiffness, fatigue, pain, and emotional changes may also contribute to difficulty with intimacy.
Because of the highly individual nature of multiple sclerosis, simply having the condition doesn’t mean you will inevitably experience these difficulties, emphasizes Dr. Laitinen. But being aware that these symptoms can be related to MS may encourage people to seek medical attention rather than assuming they are experiencing natural changes related to aging.
Multiple Sclerosis Symptoms in Older Adults
The vast majority of people with multiple sclerosis are diagnosed between the ages of 18 and 50, but it is possible for late-onset multiple sclerosis to occur after that point. A study in JAMA Neurology found that about 5% of people with MS were diagnosed after 50.
Regardless of age, symptoms vary from one person to the next, although statistically, seniors may experience faster progression of the disease, according to Dr. Laitinen. Still, “there are some older adults with MS with minimal symptoms and some younger people with MS with significant symptoms,” she says. “However, as a person with MS gets older, some may experience general progression or worsening of their symptoms, manifesting as worsening bladder function or decreased walking endurance.”
Why Do MS Symptoms Come and Go?
A particularly challenging aspect of MS is that symptoms can become intense, and then suddenly lessen, which contributes to the unpredictability of the condition. Known as a multiple sclerosis flare-up or relapse, this temporary increase in symptom intensity is due to a cascade of inflammation that takes two to four weeks to subside, says Dr. Laitinen. When it resolves, there tends to be an improvement in symptoms.
“The nervous system generally has some level of recovery, and the extent varies from person to person,” she says. “Some people recover fully and become asymptomatic; others may have slight residual symptoms, and others may not recover.”
In general, if someone is dealing with stressors such as an infection, significant emotional stress, or sleep deprivation, this may cause symptoms to happen more frequently or with more severity.
How Are Multiple Sclerosis Symptoms Evaluated?
If early symptoms like the ones above are occurring, being evaluated by a specialist such as a neurologist is recommended, suggests Dr. Azeem. “A thorough history and clinical examination will help identify areas of the nervous system that are affected, and this is confirmed with an MRI, which is more detailed than a CT scan,” he says. Imaging of the brain and spinal cord can identify where MS lesions are located.
If you have not yet been diagnosed with multiple sclerosis, a common next step is to perform a lumbar puncture (also known as a spinal tap) to test the spinal fluid for inflammation. If further confirmation is needed, providers may choose to test the functioning of the optic nerves, he adds.
Other symptoms are evaluated based on your description and the extent to which symptoms affect your daily life, says Dr. Laitinen. These might include issues like fatigue, difficulty with coordination, emotional health changes, slowness with walking speed, muscle weakness, and sexual function.
As with any condition, it’s helpful to jot down any symptoms in advance of the appointment, including how long they last and whether they are disruptive to daily activities. Identifying new or changing symptoms of multiple sclerosis early can help with adjusting MS treatment and slowing the disease’s progression.
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