Multiple sclerosis (MS) has many signs and symptoms that may confuse the individual and their loved ones. To help you know when it is time to seek a doctor, this article will address the following:

• What is multiple sclerosis?
• What are the typical first signs of MS?
• What is the traditional course of the disease?
• What conditions are often confused with multiple sclerosis?
• Where can I get more information about MS?

What is multiple sclerosis (MS)?

As covered in our Quick Facts article, MS is a progressive immune-related disorder in which the system designed to keep the body healthy mistakenly attacks parts of the body that aren’t harmful. The disease attacks the protective coverings of nerve cells, which causes diminished function in the brain and spinal cord.

What are the typical first signs of MS?

Signs and symptoms of MS vary widely between patients and depend on the location and severity of nerve fiber damage in the central nervous system. One of the more obvious first signs of MS is a problem with vision, known as optic neuritis. 

Other symptoms include:

• Numbness or weakness in one or more limbs that typically occurs on one side of your body at a time
• Stiffness
• Pains and spasms
• Tingling
• Electric-shock sensations that occur with specific neck movements, especially bending the neck forward (Lhermitte sign)
• Loss of balance and dizziness
• Lack of coordination
• Unsteady gait or inability to walk
• Prolonged double vision
• Blurry vision
• Overheating during exercise
• Vertigo
• Problems with sexual, bowel, and bladder function
• Slurred speech, also called dysarthria
• Problems with memory and thinking
• Cognitive problems
• Mood disturbances
• Weakness or fatigue

One of the common symptoms of MS is communication difficulties, which can significantly impact a person's ability to effectively communicate. This may include difficulties with speaking, understanding speech, and using language. 

People with MS may experience slurred speech, stuttering, and aphasia, a decrease in their ability to find the right words or to recall words they want to use. They may also have trouble with their hearing, which can make it difficult to understand what others are saying. These communication difficulties can have a profound effect on a person's quality of life and can impact their ability to work, socialize, and maintain relationships.

What is the traditional course of the disease?

Most people with MS have a relapsing-remitting disease course. This means:

• Symptoms appear over days or weeks
• There is a quiet period of disease remission that can last months or even years
• Symptoms reappear (relapse), sometimes worse than previously experienced.

At least 20% to 40% of those with relapsing-remitting MS (RRMS) will develop a steady progression of symptoms within 10 to 20 years from disease onset. This is known as secondary-progressive MS (SPMS).

Some people experience a gradual onset and steady progression of signs and symptoms without relapses, known as primary-progressive MS (PPMS). 

The MS Society has produced a pamphlet that thoroughly explains the course of multiple sclerosis.

What conditions are often confused with multiple sclerosis?

Other diseases can be confused with MS, including:

• Acute Disseminated Encephalomyelitis (ADEM)
• Systemic Lupus Erythematosus (SLE)
• Lyme disease (LD)
• Human T-cell lymphotropic virus-1 (HTLV-1)
• Fibromyalgia 
• Vitamin B12 deficiency
• Muscular dystrophy (MD)
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
• Migraines
• Hypothyroidism
• Hypertension
• Beçhets
• Arnold-Chiari deformity
• Mitochondrial disorders

To confirm the diagnosis of MS, your healthcare provider must be able to rule out other possible diagnoses. Some are easy to rule out with a simple blood test, while others may require a biopsy. 

Where can I get more information about MS?

Ability Central hosts a library of articles about MS to address your most pressing questions, including:

• Multiple Sclerosis (MS) Quick Facts: 6 things to know
• Multiple Sclerosis (MS): What to do after receiving the diagnosis
• Multiple Sclerosis (MS): Your rights and support options