Common Multiple Sclerosis Symptoms

Multiple sclerosis is a disease of the central nervous system (CNS) with symptoms that can affect almost anything from head to toes. The disease is so variable that no two people with MS are likely to have exactly the same combination of symptoms. As MS symptoms mimic dozens of other conditions, it is also important to consider that this list is not exclusive to MS.

Here are 50 of the most common MS symptoms:

Sensory problems

• Abnormal sensations (dysesthesias)
• Numbness, tingling, burning, or tightness
• Pins and needles
• Severe itchiness (pruritus)
• Hypersensitivity to touch
• Pain - acute or chronic, mild to severe
• Loss of proprioception (sense of body position in space)
• Inability to detect vibrations
• Impaired sense of taste or smell
• Trigeminal neuralgia - stabbing pain in the face
• L’Hermitte’s sign - electrical shock-like sensation running down the spine and into the limbs when you bend your neck forward or backward
• The MS hug

Motor problems

• Loss of strength or muscle weakness
• Loss of muscle tone (hypotonicity) or increased muscle tone (hypertonicity)
• Spasticity - continuously contracted muscles and/or muscle spasms
• Myoclonus - sudden involuntary muscle contractions
• Tremor
• Foot drop
• Problems walking, impaired gait, or mobility problems
• Paralysis
• Loss of balance
• Loss of coordination (ataxia)

For more MS symptoms, read this post in its entirety:

Top 50 MS Symptoms

Marcus Gunn Syndrome and Multiple Sclerosis

One test which my neurologist, ophthalmologist, and primary care doctor each conduct during every office visit is the “swinging flashlight test.” You know the one. The doctor asks you to look ahead then shines a penlight first toward one eye, then the other, alternating quickly to observe your pupils’ response to light.

I strangely enjoy this test because I know that my pupils will show something unique. Something which proves that I have damage to my optic nerve. My pupils show a Relative Afferent Pupillary Defect (RAPD) or Marcus Gunn Sign.

What does the doctor look for during the “swinging light test”?

The pupils (the black centers of the eyes which dilate or constrict in response to light) are inspected for size, equality, and regularity. Did you know that the pupils will constrict or dilate when you look at objects far or near? They do, which is kinda cool.

More importantly, each pupil should constrict quickly and equally during exposure to direct light and to light directed at the other pupil (the consensual light reflex). Using the swinging light test, the doctor can test and observe the pupillary response to consensual light in order to determine if there is a defect present.

Normally, the pupil constriction does not change as the light is swung from eye to eye. When the light is moved quickly from eye to eye, both pupils should hold their degree of constriction.

What is a Relative Afferent Pupillary Defect?

The Afferent Pupillary Defect (APD) or Relative Afferent Pupillary Defect (RAPD) is an abnormal and unequal response in the pupils of the eyes when exposed to light. It basically demonstrates that one optic nerve transmits a different message to the brain than the other one. Testing for RAPD is a good way to implicate or rule out optic nerve damage such as is caused by optic neuritis.


My temporarily blinding case of optic neuritis in 2000 left my right eye impaired. It doesn’t register light in the same way as my left eye as the optic nerve has permanent damage. When the doctor shines the light in my left eye (the “good” eye), both pupils will constrict. This is normal. When the doctor quickly moves the light to my right eye (the “bad” eye), my pupils begin to dilate since the brain thinks that less light is coming in. This shows that there is damage to the corresponding optic nerve.

Read this post in its entirety:

MS Signs and Symptoms: What is Marcus Gunn Syndrome?

Nystagmus and Multiple Sclerosis

Nystagmus is a condition that causes the eyes to make quick, repetitive, uncontrolled movements — from side to side, up and down, or in a circular pattern — making the eyes appear to bounce around. The jerky motion may be triggered by optical stimuli or physical motion, or may occur at rest.

Nystagmus can be mild, occurring only when a person looks to the side, or it may be severe enough to impair vision. Nystagmus often makes it difficult to focus steadily on a fixed object.

What causes nystagmus?

Nystagmus can be an inherited condition, showing up in early childhood, or it can develop later in life due to an accident or illness. Nystagmus is often a symptom of an underlying medical problem, such as stroke, multiple sclerosis, or head trauma. Other causes of nystagmus include severe nearsightedness, albinism, inflammation of the inner ear, central nervous system diseases, and medication side-effects. Sometimes the cause may be unknown.


In persons with multiple sclerosis, lesions in the brainstem and cerebellum may interfere with the nerve signals that affect motion of the eyes causing nystagmus. According to the MS Foundation, approximately 35 percent of individuals with multiple sclerosis may develop nystagmus. Abnormal gaze-holding mechanisms, vestibular imbalance, and impaired fixation are the most common causes of nystagmus in multiple sclerosis.

Read this post in its entirety:

MS Signs and Symptoms: What is Nystagmus?

Why Does the Neurologist Tap My Finger?

The neurologist is looking to see if there is a finger flexor response.  The finger flexor response is demonstrated by a sudden flexing of the thumb and/or index finger.  There are two ways to cause this response:

• The doctor snaps or flicks the nail of the middle or 4th finger.  A positive finger flexor response elicited in this manner is known as the Hoffmann reflex or sign.
  
• The doctor holds the middle finger while partially flexing it between his/her finger and thumb, then taps or flicks the underside of that finger.  A positive finger flexor response elicited in this manner is known as the Trömner sign.
  

What causes the thumb to flex?

The finger flexor response (Hoffmann relex or Trömner sign) is somewhat similar to the Babinski sign in that it is suggestive of a lesion or impingement along the corticospinal tract.

What is the corticospinal tract?

Very long nerve axons which originate in the part of the brain called the cerebral cortex travel through the brainstem, cross over at the top of the cervical spine and travel down each side of the spinal cord. This path is the corticospinal tract which is sometimes called the pyramidal tract since the area where the crossover of nerves occurs has a pyramid-like shape.

Corticospinal tract neurons are referred to as “upper motor neurons” but they do not control muscles directly. Neurons in the ventral horn that directly innervate (or stimulate) muscle are called lower motor neurons.  It is damage in lower motor neurons which causes atrophy of muscle, while damage in upper motor neurons does not.

How do the Hoffmann or Trömner signs differ from the Babinski sign?

Each of these signs indicate damage in the corticospinal tract. The Babinski sign indicates damage anywhere along the corticospinal tract. However, the Hoffman and Trömner signs are a bit more specific in that they indicate a lesion or damage above the C5 or C6 level of the cervical spine.

Read this post in its entirety:

MS Signs and Symptoms: What is the Hoffmann Reflex?

What is Trigeminal Neuralgia?

A sharp pain explodes through your face and jaw. You think that perhaps an invisible bolt of lightning just struck without any warning. You’re not sure what happened, but you do know that you don’t want it ever to happen again. You may have experienced your first acute attack of trigeminal neuralgia.

Trigeminal neuralgia (TN), also known as the tic douloureux, prosopalgia, the “suicide disease,” and Fothergill’s disease, is a facial pain disorder characterized by brief electric shock-like pains that can occur abruptly, typically on only one side of the face and along one or more of the three branches of the trigeminal nerve. The trigeminal nerve, which is the fifth cranial nerve, is responsible for sensation in the face and motor function controlling the jaw.

The stabbing pain of TN most often affects the right side of the face. Frequency of attacks can range from one per day to 12 or more per hour. Common triggers of TN include chewing, talking, or smiling; drinking cold or hot fluids; touching, shaving, brushing your teeth, or blowing your nose; or sudden contact with cold air.

An individual can often point out exactly where the pain of TN is felt. In the majority of cases, the pain shoots from the corner of the mouth to the back of the jaw. In fewer cases, the pain spreads from the upper lip or teeth up to and around the eye and eyebrow.

There are two patterns of pain in trigeminal neuralgia. The first pattern is episodic and affects more than 50 percent of patients. The second pattern features constant pain, the mechanisms and development of which are not well understood. In episodic cases, the intensity of the pain typically increases from simply being present to an excruciating pain felt deep in the face in less than 20 seconds. Muscle spasms may accompany the pain.

Read this post in its entirety:
MS Signs and Symptoms: What is Trigeminal Neuralgia?

Nystagmus and Multiple Sclerosis

Nystagmus is a condition that causes the eyes to make quick, repetitive, uncontrolled movements - from side to side, up and down, or in a circular pattern - making the eyes appear to bounce around. The jerky motion may be triggered by optical stimuli or physical motion, or may occur at rest. Nystagmus can be mild, occurring only when a person looks to the side, or it may be severe enough to impair vision. Nystagmus often makes it difficult to focus steadily on a fixed object.

Nystagmus can be an inherited condition, showing up in early childhood, or it can develop later in life due to an accident or illness. Nystagmus is often a symptom of an underlying medical problem, such as stroke, multiple sclerosis, or head trauma. Other causes of nystagmus include severe nearsightedness, albinism, inflammation of the inner ear, central nervous system diseases, and medication side-effects. Sometimes the cause may be unknown.

In persons with multiple sclerosis, lesions in the brainstem and cerebellum may interfere with the nerve signals that affect motion of the eyes causing nystagmus. According to the MS Foundation, approximately 35 percent of individuals with multiple sclerosis may develop nystagmus. Abnormal gaze-holding mechanisms, vestibular imbalance, and impaired fixation are the most common causes of nystagmus in multiple sclerosis.

I’ve been one of those 35 percent as I developed mild nystagmus about seven years ago. Mine is triggered by visual stimuli such as looking up and down repeatedly between the piano keyboard and music while I’m teaching. The nystagmus which develops can be somewhat disorienting.

Treatment for nystagmus depends upon the type of abnormal eye movements involved.

Read this post in its entirety:

MS Signs vs Symptoms: What is Nystagmus?

Numbness as a Sign and Symptom of MS

Numbness is often associated with other symptoms such as tingling (pins-and-needles), weakness, pain, difficulty walking, and increased risk of falls. When a person experiences complete numbness (anesthesia), delayed reaction to harmful situations such as deep cuts or exposure to hot temperatures can be dangerous. You must always remain vigilant.

What causes numbness?

Sensory information travels along nerve pathways. Disruption anywhere along these pathways can cause numbness or other sensory alterations. Common causes of numbness include demyelinating disorders such as multiple sclerosis, strokes, vasculitis, nerve compression, infections, vitamin deficiency, toxins or drugs, diabetes, or hereditary neuropathies.

How is numbness clinically evaluated?

Because there are so many possible causes of numbness, evaluation is done methodically. The doctor must determine which part of the nervous system is involved. Then, the doctor takes a thorough medical history to determine a differential diagnosis (ie, possible cause). Describe the numbness; when did it start; how long does it last; where is it located; are there other neurologic symptoms; do you suspect a possible cause such as recent trauma or infection?

A review of systems will help to identify other symptoms of disorders that may explain the numbness. Examples include back or neck pain (caused by arthritis or spinal cord compression), fever or rash (infectious neuropathy), joint pain (rheumatic disorders), headache (brain tumor or stroke), undernutrition (vitamin B12 deficiency), or excessive consumption of high-mercury seafood (polyneuropathy).

Past medical history is considered, as well as family history of neurologic disorders. A complete neurologic exam helps to determine the location and extent of the numbness and identify neurologic deficits in related reflex, motor, or sensory function. Testing may include laboratory tests, nerve conduction studies, magnetic resonance imaging (MRI), or CT scans.


Read this post in its entirety:

MS Signs & Symptoms: Numbness

Signs of Nerve Damage Seen in the Pupils of the Eyes

One test which my neurologist, opthalmologist, and primary care doctor each conduct during every office visit is the “swinging flashlight test.”  You know the one.  The doctor asks you to look ahead then shines a penlight first toward one eye, then the other, alternating quickly to observe your pupils’ response to light.

I strangely enjoy this test because I know that my pupils will show something unique.  Something which proves that I have damage to my optic nerve.  My pupils show a Relative Afferent Pupillary Defect (RAPD) or Marcus Gunn Sign.

What does the doctor look for during the “swinging light test”?

The pupils (the black centers of the eyes which dilate or constrict in response to light) are inspected for size, equality, and regularity.  Did you know that the pupils will constrict or dilate when you look at objects far or near?  They do, which is kinda cool.

More importantly, each pupil should constrict quickly and equally during exposure to direct light and to light directed at the other pupil (the consensual light reflex).   Using the swinging light test, the doctor can test and observe the pupillary response to consensual light in order to determine if there is a defect present.

Normally, the pupil constriction does not change as the light is swung from eye to eye.  When the light is moved quickly from eye to eye, both pupils should hold their degree of constriction.


Read this post in its entirety:

MS Signs vs. Symptoms: What is a Marcus Gunn Pupil?

What is the Romberg Test?

During each visit with the neurologist, I get to go through the steps of testing balance and gait.  The term gait refers to how you walk.  It’s fun getting to show off my abilities on any given day.  However, there is one particular neurological test which always gives me a chuckle.  It is the Romberg Test.

"What is the Romberg Test?"

The Romberg Test is a neurological test which detects poor balance and defects in proprioception.  The test involves standing with your feet together and closing your eyes.  The doctor will observe how you are able to maintain your balance and an upright posture.  The doctor may even push you slightly to see whether you are able to compensate and maintain an upright posture.

The very first time I underwent this testing, I thought that my neurologist had shoved me in the middle of the back.  He quickly told me to open my eyes.  My mother, who had come with me to the visit, told me later that he had caught me as I was quickly falling backwards.  I had no idea.  I had demonstrated a positive Romberg sign.

During the past couple of years, I don’t even need to close my eyes when I’m standing with my feet together before I begin to sway and wobble.  I can’t feel my feet which makes feeling their positioning more difficult.  As a result, I hardly ever stand with my feet together and I definitely don’t close my eyes in the shower.  My physical therapist even has a nifty testing device which can map the amount of swaying I do under different circumstances.


Read this post in its entirety:

MS Signs vs. Symptoms: What is the Romberg Test?

What is the Hoffmann Reflex?

During one of my early visits with the neurologist, he conducted a test of which I didn’t understand the significance.  He’d already asked me to squeeze his fingers in my fists - “oh come on, squeeze harder” - and now he is ‘thumping’ my fingers.

“What is the neurologist looking for when he is tapping my finger?”

The neurologist is looking to see if there is a finger flexor response.  The finger flexor response is demonstrated by a sudden flexing of the thumb and/or index finger.  There are two ways to cause this response: 
     * The doctor snaps or flicks the nail of the middle or 4th finger.  A positive finger flexor response elicited in this manner is known as the Hoffmann reflex or sign.
     * The doctor holds the middle finger while partially flexing it between his/her finger and thumb, then taps or flicks the underside of that finger.  A positive finger flexor response elicited in this manner is known as the Trömner sign.

To view two videos of a positive Hoffmann sign, visit the website of the University of Washington Neurological Surgery Spine Center.

“What causes the thumb to flex?”

The finger flexor response (Hoffmann relex or Trömner sign) is somewhat similar to the Babinski sign in that it is suggestive of a lesion or impingement along the corticospinal track.


Read this post in its entirety:

MS Signs vs. Symptoms: What is the Hoffmann Reflex?

The Babinski Sign Explained

While I’m sitting on the exam table with my legs dangling, the neurologist reaches for a metal object.  He’s already poked me several times with the safety pin so I’m wondering what he plans to do with this larger pointy thing.  He grasps my foot and scraps the object on the bottom of my foot along the outermost side and under the toes.  My big toe jumps and the other toes look like they are trying to get away from the torture device.  I have just demonstrated a positive Babinski sign.

During a standard neurological exam, the doctor will test many reflexes, or involuntary responses to stimuli.  Much of that is done with a rubber mallet as the doctor taps various tendons and measures the response.  However not all reflex tests involve the rubber mallet.  One very important reflex test involves scraping the bottom of the foot.

“When the doctor scraps the bottom of my feet, what is he looking for?”

A normal response in anybody older than two years of age would be the big toe flexing downward (toward the sole of the foot) or nothing.  If your big toe jumps upward or extends (even if for a very brief second) and/or your toes fan out, this would be a “positive” extensor plantar response or the Babinski sign.


Read this post in its entirety:

MS Signs vs. Symptoms: What is the Babinski Sign?

What is L'Hermitte's Sign?

The neurologist asks me to bend my head forward and immediately I feel a shock of sensation travel down my arms into my fingers.  It’s kind of a vibration, buzzing, or tingling more than a shooting pain.  I have just shown a positive L’Hermitte's sign.

The extra buzzing I felt is called a dysesthesia since the unusual sensation was provoked by bending my head forward, in contrast to a paresthesia which describes spontaneous tingling, buzzing, partial numbness, sharp pains, or electrical shocks.  I get those too.

Not everybody experiences the L’Hermitte's symptom in the same way.  For some patients, it is described as an intense electric shock which feels like you’ve just shoved a finger or toe into an electrical outlet.  For some, it may just be a very subtle tingling in the fingers, legs, or toes.  Or for others, the wave of sensation can also travel down the truck or upwards to the head.

I have been asked, “Is L’Hermitte's a sign or a symptom?”


Read this post in its entirety:

Signs vs. Symptoms: What is L'Hermitte's Sign?