Early Signs of MS

Around 1 million people in the United States are living with multiple sclerosis (MS) according to the American Academy of Neurology. MS is a chronic disease that can affect your brain, spinal cord, and the optic nerves behind your eyes. It’s most often diagnosed in adults between the ages of 20 and 40, but can occur in young children and older adults as well.

MS causes your immune system to attack myelin, a fatty substance wrapped around your nerves.

Although there is no known cure for MS, there are effective treatments that can reduce the risk of attacks and slow the course of the disease. With early detection and treatment, you may be able to help slow its progression. “It’s important to get treatment [as soon as possible] to prevent longer-term damage to your nervous system,” says Michael Levy, MD, PhD, a Mass General Brigham Neuroscience Institute neuroimmunologist.

If you’re concerned about MS, you may be wondering what to look for and when to seek care. Dr. Levy discusses the early signs and symptoms of MS, how MS is diagnosed, and the latest research into treatment.

What are the early symptoms of MS?

MS can cause a wide range of symptoms, the most common of which include:

• Trouble walking or difficulty with balance
• Feeling tired or fatigued
• Muscle weakness, spasms, and tremors
• Blurred or double vision
• Sudden loss of vision
• Numbness and tingling
• Sexual problems
• Oral health problems, including MS tongue, swallowing problems, and dry mouth
• Poor bladder or bowel control
• Pain, particularly trigeminal neuralgia (pain in the face that feels like an electric shock)
• Depression
• Problems focusing or remembering, sometimes called brain fog

You might only experience one symptom or a combination of symptoms. The symptoms may be constant or can come and go.

If you experience any of these symptoms, call your primary care provider (PCP). The sooner you can get a diagnosis and start treatment, the more effective treatment can be at slowing disease progression and managing your symptoms.

Vision problems

For many, vision problems are one of the first symptoms of MS. Specifically, people living with MS may experience inflammation of the optic nerve (the nerve responsible for vision). This is called optic neuritis and can lead to blurred or double vision, pain, or temporary vision loss.

Because cataracts can also create cloudy vision or double vision, people often wonder: Are cataracts an early sign of MS? This does not appear to be the case.

Vision problems can be symptoms of MS but also may be a sign of another autoimmune or neurological condition. See a health care provider quickly for any sudden vision loss. Your eye doctor checks your optic nerve during routine exams and may be able to identify a problem before you experience other symptoms.

Dizziness and vertigo

Many people who are concerned about symptoms of MS wonder about dizziness and vertigo as well. Is vertigo an early sign of MS? It can be—but it isn’t necessarily, either. MS symptoms often vary from person to person, so while one person experiences vertigo, another may not.

Sex-specific symptoms of MS

Although people with MS can experience most of the same symptoms, there are a handful of sex-specific symptoms to be aware of. It’s important to know, however, that there are many other reasons people may be experiencing symptoms like those listed below.

Dr. Levy explains, “Even though people with MS may experience these symptoms, they are most often caused by something other than MS.”

Early signs of MS in women

Both women and men can be diagnosed with MS. However, the condition is more common in women and people assigned female at birth (AFAB). In fact, studies show that women are three times more likely to develop the condition than men.

Symptoms specific to women can include:

• Vaginal dryness
• Sexual dysfunction
• Amenorrhea—the absence of a period

Women and people AFAB diagnosed with MS who menstruate may experience an increase in their symptoms, such as depression, fatigue, and weakness during their period.

Menopause can also have an impact on women with MS. Research has found that some women report a worsening of MS symptoms after menopause. But others note that menopause reduced their rate of relapse.

People living with MS who are hoping to become pregnant may worry about the impacts of the condition on their future. While it’s important to speak with your provider about getting pregnant while living with MS, there is hope. Patients can get pregnant and raise families while managing their MS symptoms and treatment.

Early signs of MS in men

MS symptoms specific to men and people assigned male at birth (AMAB) may include sexual health concerns like:

• Erectile dysfunction
• Decreased libido
• Anorgasmia—orgasms that become absent, less frequent, less intense, or delayed

Men and people AMAB living with MS are more likely than women to experience:

• A loss of coordination
• Poor balance
• Cognitive impairments such as problems with memory, learning, concentration, or decision-making

What causes MS?

Knowing the signs and symptoms of MS can be helpful in getting your diagnosis. However, the specific cause of the disease is still unknown. 

“Unfortunately, as of right now, we don’t know exactly what causes MS,” says Dr. Levy. “There are many factors that make someone at higher risk for developing it, such as smoking, certain infections, and vitamin D deficiency. Autoimmune disorders can affect your MS, too.”

Recent research published in the journal Science suggests that MS may be related to the common Epstein-Barr Virus (EBV). People with MS have a much higher rate of EBV infection than people without MS, but plenty of people get EBV without ever getting MS. It’s unlikely that an EBV infection alone causes MS, but the research suggests that it’s an important part of the chain of events that contributes to someone developing MS.

Is MS inherited?

While MS is not directly inherited—meaning it’s not passed down from one generation to the next—you’re more likely to be diagnosed with MS if a parent or sibling has it. If you have a family history of MS or other autoimmune conditions, it’s a good idea to pay attention to changes in your body and mind that might be early signs of the disease.

How is multiple sclerosis diagnosed?

There isn’t one specific test for MS diagnosis. During the diagnosis process, your health care provider looks for evidence of MS such as lesions on the brain, spinal cord, or optic nerve and proteins or other biomarkers in your blood and spinal fluid.

The combination of your symptoms, personal and family health history, exam findings, and test results helps your doctor diagnose you with MS.

Are MS and Parkinson’s disease related?

While there are some similarities in symptoms—like changes in movement—there are many differences between MS and Parkinson’s disease, too.

“Both conditions can cause tremors,” says Dr. Levy. “But these distinct diseases have different causes, diagnostic tests, and treatments.”

How is MS treated?

MS is treated with a combination of medications called disease-modifying therapies (DMTs), medications or treatments for symptom management, and supplements and integrative medicine.

Discuss your lifestyle and treatment goals with your health care provider. They help you choose the treatment options that can best support you.

Living a healthy lifestyle can help you feel better with MS. To help manage MS:

• Get adequate sun exposure and take a vitamin D.
• Eat healthy foods.
• Stay active.
• Reduce stress.

Is there a cure for MS?

Unfortunately, there is currently no known cure for multiple sclerosis. However, patients can live happy and healthy lives, especially when they focus on treatment, symptom management, and healthy lifestyle choices.

“There are many effective medications available to reduce the risks of attacks and slow the course of MS,” says Dr. Levy. “Most of these medications are well tolerated in the long term and allow you to return to your previous lifestyle. There are also strategies to ease your symptoms and help you manage the stress and physical pain that can come with the condition.”

Researchers are searching for a cure for MS. Mass General Brigham is on the forefront for ongoing care, education, and study for this disease.

Advances in MS research

Mass General Brigham Neuroscience Institute researchers are conducting innovative research and studies to learn more about MS and find better treatments. These include:

• Foralumab nasal spray treatment: Researchers recently completed a phase 1 clinical trial of foralumab, which shows promise in reducing MS symptoms and improving the quality of life for those living with MS.
• Advanced imaging technology: Scientists are using advanced scanners like the Connectome 2.0 and new MRI techniques to take detailed pictures of the brain. These images help them see how MS damages the brain and affects memory and movement. This could lead to better ways to treat MS.
• MRI study on axon damage: Researchers are studying axon damage in MS, which can affect thinking and movement. Their research plays a key role in finding better ways to monitor and treat MS.
• Wearable device study: Researchers are testing a smart insole that monitors MS symptoms, such as gait and balance, right at home. This device could help doctors detect changes in symptoms earlier.
• Precision medicine and biomarkers: Researchers are working on ways to better match MS treatments to each person. They are studying certain genes, proteins, and other markers in the body that could help doctors predict how the disease will progress and which treatments will work best. This research could help create more personalized care for people with MS.

With ongoing research and promising new treatments like foralumab, there is hope on the horizon for those living with multiple sclerosis.