Characteristic Symptoms of MS

Clinical presentations in MS include¹⁴:

• loss or reduction of vision in 1 eye with painful eye movements
• double vision
• ascending sensory disturbance and/or weakness
• problems with balance, unsteadiness or clumsiness
• altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte’s symptom).

People with MS present with symptoms or signs as described above, and:

• are often aged under 50 and
• may have a history of previous neurological symptoms and
• have symptoms that have evolved over more than 24 hours and
• have symptoms that may persist over several days or weeks and then improve.

MS should not routinely be suspected if a person’s main symptoms are fatigue, depression or dizziness unless they have a history or evidence of focal neurological symptoms or signs.

The underlying pathophysiology accounts for some of the characteristic symptoms of MS:

• Partially demyelinated fibres conduct slowly, explaining symptoms relating to physiological fatigue
• Partially demyelinated fibres can also discharge spontaneously giving rise to unpleasant distortions of sensation
• Increased mechanical sensitivity of neurones can give rise to symptoms induced by movement such as flashes of light on eye movement and an electric shock sensation felt in the spine or legs on neck flexion (Lhermitte’s symptom)
• Conduction can fail with an increase in temperature, accounting for temporary exacerbations of symptoms on exercise or after a hot bath (Uhthoff symptom)

MS lesions characteristically involve the optic nerve and peri-ventricular white matter of the cerebellum, brain stem, basal ganglia and spinal cord. The peripheral nervous system is rarely involved.

Learning-bite

MS is characterised by episodes of multiple neurological dysfunction, e.g. vision and sensory disturbances, limb weakness, gait problems and bladder and bowel symptoms followed by incomplete recovery.