In multiple sclerosis, or MS, your immune system attacks myelin, the fatty tissue that surrounds and protects nerve fibers.

This causes scar tissue (sclerosis, also called plaque or lesions) to form on nerve fibers, disrupting the flow of electrical impulses throughout the nervous system.

This nerve damage can lead to a range of MS symptoms.

Fever, hot baths, sun exposure, and stress may trigger or temporarily worsen symptoms.

Early Symptoms of MS

Symptoms of MS vary widely in people, and the various forms of MS sometimes include different symptoms.

So it’s not possible to predict how the disease will progress in any one person.

However, people with MS often experience vision problems first, including blurred or double vision, color distortions, and a condition called optic neuritis, which causes eye pain and rapid loss of vision.

Other early symptoms can include:

  • Muscles that are weak, stiff, and oftentimes painful
  • Tingling, prickling, or numbing sensations (“pins and needles”) in the arms, legs, torso, or face, known as paresthesia
  • Balance problems and clumsiness
  • Difficulties controlling the bladder or urgency to urinate
  • Prolonged dizziness

Other Symptoms of MS

Fatigue is one of the most common symptoms of MS, affecting about 80 percent of people who have the disease, according to the National Multiple Sclerosis Society.

You may experience being tired all day long or become easily fatigued from mental or physical exertion.

Other common MS symptoms include:

  • Vertigo
  • Sexual problems, such as erectile dysfunction, vaginal dryness, and the inability to orgasm
  • Difficulty walking due to muscle weakness, spasticity, loss of balance, sensory deficits, and fatigue
  • Constipation and incontinence
  • Cognitive impairments affecting concentration, attention, memory, problem-solving, and judgment
  • Clinical depression
  • Other emotional changes, such as mood swings, irritability, and uncontrolled laughing and crying

Less common symptoms of MS include:

  • Slurred or difficult-to-understand speech, as well as the inability to produce voice sounds (dysphonia)
  • Uncontrollable shaking or tremor
  • Paralysis
  • Respiratory problems
  • Difficulty chewing and swallowing
  • Seizures
  • Itchy skin (pruritus)
  • Hearing problems
  • Headaches, particularly migraines

Multiple Sclerosis Pain

General pain — including headaches, muscle pain, and chronic back or other musculoskeletal pain — and specific pain syndromes are commons symptoms of MS.

In fact, about 63 percent of people with MS experience pain, according to a 2013 report in the journal Pain.

The study found that headache and neuropathic (nerve) pain in the extremities are the most common types of pain that people experience, affecting 43 percent and 26 percent of people with MS, respectively.

The least common type of MS pain is in the face known as trigeminal neuralgia, according to the study.

Trigeminal neuralgia is a kind of sharp and stabbing pain in the face that originates from damage to the trigeminal nerve, which is responsible for facial motor functions and sensations. It’s sometimes confused with dental pain.

Another common type of pain from MS is what’s known as Lhermitte’s sign, which is a brief and sharp electric-shock-like sensation that runs from the back of the head down the spine and into the limbs.

People often feel Lhermitte’s sign when they bend their neck forward.

MS Diagnosis

Multiple sclerosis can be difficult to diagnose.

Besides the fact that no single test can detect the disease, MS symptoms can mimic those of a number of other conditions, and they can change over time.

Symptoms can also vary from person to person — and from day to day in the same person.

To diagnose the disease, healthcare providers use a number of tools and tests that help rule out other possible causes.

Medical history: Doctors ask for details about personal and family health history, and question patients carefully about symptoms, their duration, and their onset.

Physical examination: A physical exam will most likely include tests to determine the health of nerves and muscles.

Doctors may look for weakness in specific parts of the body, uncoordinated eye movements, and problems with balance, vision, and speech.

Magnetic resonance imaging (MRI): If doctors suspect MS after an exam, they will order additional diagnostic tests, starting with an MRI.

In MS, doctors take scans of the brain or spine depending on the symptoms and physical exam.

The resulting pictures can show patches, or scars, in the central nervous system where myelin has been destroyed.

Since other disorders can cause these plaques, an MRI scan can’t provide definitive evidence of multiple sclerosis, but doctors rely primarily on MRIs to see evidence of the disease.

MRIs are also important in tracking the progress of the disease, and doctors may order new tests from time to time to monitor a patient’s condition.

Cerebrospinal fluid collection (CSF collection): If the diagnosis is not clear, doctors may take a sample of spinal fluid.

Doctors examine the sample for abnormalities associated with MS, such as an increase in white blood cells and high levels of an antibody called immunoglobulin G.

Evoked response tests (ERTs): These electronic tests, sometimes called evoked potential tests, measure the speed of brain connections.

The most common ERTs are the visual evoked response test (VER), the brain stem auditory evoked response test (BAER), and the sensory evoked response test (SER).

In each of these tests, doctors attach wires to a patient’s scalp. Then, depending on the test, they give patients visual, auditory, or sensory stimulation.

These stimuli are a checkerboard pattern patients see on a monitor, a series of clicks they hear through earphones, or short electrical impulses they feel on an arm or leg.

The tests measure the speed of visual, hearing, and sensory pathways, and can detect areas in the brain that may have been damaged by MS.