Early Signs of MS: Earliest Warning Symptoms of Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory, demyelinating disease principally affecting young adults, characterized pathologically by presence of numerous area of demyelination of central nervous system (CNS) and clinically by neurological symptom which have a tendency toward remission and exacerbation.

The etiology remains unresolved, though evidence suggest that an environmental agent, most likely viral may be responsible in a genetically susceptible person.

Symptoms of Multiple Sclerosis

• Onset – common mode of onset are
  • Spinal cord involvement
    • Sudden onset of weakness or paresis of lower limb.
    • Impairment of cutaneous sensation in lower limbs and trunk.
  • Brain stem symptoms such as vertigo, diplopia (double vision) and ataxia.
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• Motor symptoms – weakness of legs commonly seen weakness of one leg after excretion with recovery after rest but with subsequent progression.
• Sensory changes – paraesthesia (sensory loss) is commonly seen. Pain is usually rare in MS. There may be impairment of postural or vibration sense.
• Ocular symptom – unilateral retro – bulbar neuritis, diplopia and nystagmus (side to side movement of eyeball) are common.
• Mental symptom – emotional changes, euphoria, delusions, and dementia is seen.
• Uhthoff’s phenomenon – characterized by worsening of weakness or vision with heat e.g. hot bath or exercise.

Early Signs of MS

MS or multiple sclerosis is a CNS disorder. The myelin sheathe is a fatty tissue that encloses the nerve fibers in the spinal cord and the brain. Multiple sclerosis occurs when the myelin sheath gets damaged. The disease impairs the flow of nerve impulses through the nerves. Ms is known to occur more commonly in women. Exacerbations and recoveries are known to occur. As the disease progresses, fundamental functions like walking, talking, writing, and memory get impaired

The following are the earliest symptoms of multiple sclerosis:

• The earliest symptom is numbness of the face and body
• Weariness and exhaustion
• Tingling in the skin
• Tremors
• Balance and gait get affected
• GI derangements and upsets occur, like diarrhea / constipation / dyspepsia
• Loss of bowel function / bladder function
• Sexual dysfunction develops
• Vision gets impaired
• Muscle weakness
• Spasms of muscles
• Concentration get reduced, attention span is lowered
• Memory loss
• Judgment is affected
• Depression sets in
• Emotional swings and outbursts
• Psychosis
• Dementia
• Paranoia

Warning Signs of Multiple Sclerosis

• Chronic, general, diffuse pain all over the body
• Voice disorders
• Jerky eye movements, blindness
• Difficulty in swallowing
• Seizures
• Breathlessness
• Dysesthesia
• Paralysis
• Involuntary leg movements
• Trigeminal Neuralgia

Development of Multiple Sclerosis

• Immunological mechanisms suggested by
  • Presence of T and B lymphocytes and macrophages in areas of recent demyelination.
  • Detection of Interleukin – 2 (IL – 2) receptors on lymphocytes.
  • Cell mediated and humoral immunological abnormalities in the tissue, CSF and peripheral blood.
• Inflammation – an earliest detectable event presenting as an increase in permeability of blood – brain barrier is seen in association with inflammation.

How Multiple Sclerosis is diagnosed?

• Age of onset 10 – 15yrs.
• Lesions dissociated in time and place.
• Predominantly white matter affection.
• Interval between episodes about one month or chronic progressive over 6mths.
• Disease lasting for more than a year.

Management and Treatment for Multiple Sclerosis

No effective curative treatment available.

• Treatment modifying course of disease
  • Short course of cyclophosphamide.
  • Cytokines and cytokine inhibitors.
• Treatment of acute relapse with corticosteroids (methyl prednisolone). ACTH to shorten duration of acute relapse.
• Symptomatic treatment
  • Local nerve block with botulinum toxin incase of spasticity.
  • Isoniazid with pyridoxine in tremors.
  • Tricyclic anti – depressants for chronic dysaesthetic pain.
  • Oxybutynin for urinary frequency and urgency.
  • Desmopressin for nocturia (frequent urination at night).

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