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13 Things to Know About Early MS Symptoms

Symptoms of multiple sclerosis are varied because they are caused by damage to the central nervous system, which controls the spine, brain, and eyes.

Multiple sclerosis (MS) is a chronic and often debilitating disease that affects your brain and spinal cord. It can cause lots of different types of problems, including pain, eye problems, mobility issues, and more. Though symptoms can be varied and don’t all strike at once, a few things do raise red flags for MS. “What brings people into care most often is a sudden onset of symptoms that they’ve never had before,” says MS specialist Emily Harrington, M.D., a neurologist at the Ohio State University Wexner Medical Center in Columbus, OH.


MS Symptoms Result From Immune System Attack

Before we look at MS symptoms, it helps to understand what MS is—an autoimmune disorder. Experts don’t 100% know what causes MS, but this disease triggers your immune system to mistakenly attack the myelin sheath, which is a protective layer that surrounds nerve fibers in your central nervous system (CNS). The attack causes inflammation that damages the myelin sheath and disrupts communication between your nerves and the rest of your body. Your symptoms depend on where the attack occurs. For example, if a rogue immune response targets your optic nerve, which is part of the CNS, you will develop vision problems.


MS Symptoms Can Surprise You

MS symptoms can be both sudden and unexpected—so don’t dismiss this disease as a possibility, even if you felt great only yesterday. “Usually, people who get MS are very healthy, there’s nothing wrong with them at all,” says Rhonda Voskuhl, M.D., a professor of neurology at the University of California Los Angeles, and director of the UCLA Multiple Sclerosis Program. She says that people who get the disease are usually young, in their late teens or 20s or 30s. Women are about three times more likely to develop MS than men, according to the National MS Society.


MS Symptoms Are Different in Different People

MS typically starts with a single symptom, says Dr. Voskuhl. “It could be vision, it could be paralysis, it could be sensory loss, it could be coordination,” she explains. And that first symptom can be different for different people. “All people with MS are not alike,” she says, “and that can make it difficult for non-neurologists to diagnose it, because the presentation of the disease can be quite variable.” One clue that it’s MS and not another disease is that once the symptom begins, it continues for days or even weeks.


MS Symptoms Sometimes Start With Optic Neuritis

MS can cause eye trouble. “If it affects a visual pathway, you’re going to get vision problems,” says Dr. Voskuhl. Called optic neuritis, this occurs when the disease attacks the myelin sheath in your optic nerve. This type of inflammation typically happens in just one eye. It can cause pain, blurred vision, or things may appear grayed out. What do you do? “An ophthalmologist is a good start because they are well-trained to recognize optic neuritis,” says Dr. Harrington. “If the eye symptoms are really severe, go to the emergency room. You might require I.V. steroids to treat them.”


MS Symptoms Tend to Hang Around

If your symptoms come on suddenly—like throbbing eye pain with blurred vision, for example, or movement problems—and then linger, MS may in fact be the culprit. “With MS, the timeframe is part of the suspicion,” says Dr. Harrington. Symptoms that last less than a day or that come and go throughout the day are not likely to be caused by MS. “If it’s a day or a couple of days, it’s usually something else, like a stroke or mini-stroke, which are more common in older people but can happen in younger people,” Dr. Harrington says.


MS Symptoms Often Involve Mobility

Dr. Harrington notes that a common MS symptom people experience is muscle weakness, explaining, “that means [you] may have trouble moving an arm or a leg on one side of the body.” You also may have trouble with the way you walk. “You have balance problems or feel very wobbly or have trouble moving your legs,” Dr. Harrington says, adding that this can be dangerous: “If you have notable weakness in your arms or legs and it’s not getting better, go to the emergency room.” People with MS are at high risk of falls, according to the National MS Society.


MS Symptoms Can Include Numbness and Tingling

Sensory symptoms also are common in early MS. You may feel numbness or tingling in one of your hands, for example. That can make it difficult to write, to get dressed, or do other activities. That, like other symptoms, tells doctors where the disease has likely struck. “If it’s unilateral numbness or weakness on the arm or leg, that could be on the spinal cord or a motor center of the brain,” says Dr. Harrington. An MRI exam will pinpoint the location. It also will allow doctors to confirm a diagnosis of MS.


MS Symptoms Can Mean Total Exhaustion

We all get tired sometimes, but MS can push that feeling to extremes. “A big [early symptom] is fatigue, very serious fatigue,” says Dr. Voskuhl. “At two or three o’clock in the afternoon [you] just have to take a nap.” Also known as lassitude or MS fatigue, this symptom remains a bit of a mystery in MS. “We don’t know the exact location in the brain like we do for some of the other symptoms of MS, like vision or walking or cognition difficulties.”


MS Symptoms Often Cause Pain

Different types of pain—burning, stabbing, sharp, and squeezing—can be caused when certain nerves are damaged by MS. “Pain in the extremities, the feet and the hands, is a common symptom, and it can be hard to treat,” says Dr. Voskuhl. You may experience painful tightening of your muscles, stabbing pains in your face or jaw, or pain that runs down your spine and possibly out to your arms and legs. MS symptoms such as weakness that make your movements awkward also can cause those movements to be painful.


MS Symptoms Can Affect Speech

You also may experience trouble talking if MS has attacked certain areas of your brain, such as your brainstem. “People with MS can develop difficulty moving the mouth or making speech,” says Dr. Harrington. The medical term for this is dysarthria, and it may cause you to slur your speech or to make long pauses between words or even single syllables. Your voice may take on a nasal quality and sound as if you have a cold. Another possibility: Your voice may lose some of its volume and become difficult for others to hear.


MS Symptoms Can Include Cognitive Issues

Some symptoms may be harder to pin down as particular to MS. Cognitive fog, difficulty with heat intolerance, and mood disorders (such as depression and anxiety) can all be related to MS. “Mood disorders tend to be more common in people with MS, likely because of the inflammation that’s happening in the brain,” says Dr. Harrington. If your symptoms are caused by MS, an MRI will reveal white spots typical of the disease. “That means that someone hasn’t had a clear flare or one of those discrete neurological symptoms yet, but they may be at risk of developing MS.”


MS Symptoms Last Longer as Disease Progresses

In the beginning, your symptoms may not last as long as later MS flares, or relapses, of the disease. “Usually, the early symptoms last a week or two,” says Dr. Harrington. “That’s likely due to how long the blood-brain barrier keeps inflammation out of the brain impaired. Once that’s able to seal off and repair, the inflammation dies down and things tend to get better.” A later relapse can last several weeks or even months, though. Getting a diagnosis and into treatment as soon as the symptoms begin is critical.


MS Symptoms Need Early Treatment to Reduce Risk

“The more that we learn about MS,” says Dr. Harrington, “the more we find that early treatment predicts a better outcome in terms of reducing the amount of disability and reducing the risk of more progressive symptoms.” Dr. Voskuhl agrees. “Untreated, you’ll get damage and scarring where the attacks occurred, and as of right now, that damage is not repairable,” she says. “The main thing is prevention of these inflammatory attacks, and the way to do that is with current anti-inflammatory treatments."


This article was originally published April 4, 2013 and most recently updated May 11, 2022.