Table 1. Symptoms of Multiple Sclerosis
Blurriness in the central visual field that affects only one eye; may be accompanied by pain upon eye movement Double vision Odd sensation in legs, arms, chest, or face, such as tingling or numbness Weakness of arms or legs Heat sensitivity (symptoms worsen, reappear upon exposure to heat such as a hot shower) Loss of dexterity Difficulty coordinating movement Difficulty controlling bowel movements or urination
Patients with MS typically experience an array of sensory and motor symptoms Table 01. The most common first symptoms are weakness or numbness in one or more limbs, blurry or double vision and other sensory disturbances, and an inability to coordinate voluntary movements (ataxia). Sometimes patients experience such mild initial symptoms that medical attention will seem to be unnecessary.
Additional sensory symptoms include tingling or other unusual sensations in the extremities, trunk, or face; feelings of weakness or heaviness in the arms or legs; visual problems; vertigo, and dizziness.
Aside from ataxia, additional motor symptoms that may occur include slurred speech, unsteady gait, tremors, and loss of coordination. Spasticity is another common symptom of MS, and is characterized by abnormally tense muscles and exaggerated tendon reflexes. People with MS also often experience pain in the affected muscles during an attack.
Most patients with MS experience fatigue, which may manifest as sleepiness, mental exhaustion, or weakness.
People with MS may lose the ability to empty their bladder completely, and may also become incontinent. Bowel incontinence may occur, but constipation is more common. While most women with MS are still able to experience orgasm, men with MS may have difficulty achieving an erection.
Symptoms of MS come and go. An "attack" of symptoms typically develops over several hours or days and lasts for a few days to a few weeks. In the relapsing-remitting course of disease, the symptoms gradually improve, and a patient may or may not be left with lasting neurological effects. A person with one of the relapsing-remitting forms of MS will, on average, have an attack or relapse every two years. About 15% of people with MS will never have a second relapse.
Symptoms of MS may worsen over time, and may be triggered by certain factors or behaviors. Numbness, for example, may begin in a specific place, and then spread outward over hours or days. Blurred vision often occurs in one eye only, starting at the center of the visual field and progressing outward over time. There may also be pain behind the eye that worsens with eye movement. Patients generally recover their vision completely after an attack of this sort.
Symptoms will worsen or return with a hot shower, exercise, fever, or other exposure to high temperature.
Hyperventilation may precipitate paroxysmal attacks, which are clusters of symptoms that may occur early in the course of MS. Paroxysmal attacks are brief recurrent episodes of tingling or other strange sensations associated with muscle contraction. These attacks may last for a moment, or as long as 30 seconds.
A person with MS may develop mild intellectual or emotional changes. The most common cognitive changes are impairment of short-term memory, difficulty paying attention or shifting attention between tasks, and slowed information processing.
Having a close relative with MS, living in the northern latitudes, and being female all increase a person’s likelihood of developing MS. Studies have demonstrated a clear association between genetics and MS risk. However, researchers believe that MS is caused by an interplay of genetic mutations rather than a single gene.
The overall risk of developing MS for the general population is less than .1%.
An identical twin of a person with MS has a 31% risk of developing the disease, while a fraternal twin’s risk is 5%; a person with a sibling with MS has a 2% to 5% risk of developing MS. A person with another close relative with MS (not a sibling or parent) has eight times the normal risk of developing MS.
MS is most prevalent among people who grew up in the northern latitudes of Europe and North America. MS is most prevalent in the Orkney Islands north of Scotland. The risk for MS decreases the closer you live to the equator.
Women are twice as likely as men to develop MS.
In the US, MS is most common among Caucasians. The prevalence of MS among Japanese-Americans and African-Americans is one-quarter and one-third that among Caucasians, respectively. The disease is extremely rare among Japanese living in Japan and among Africans living in Africa. These figures suggest that environment plays a role as well as genetics.
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