Multiple sclerosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
The most common symptoms of multiple sclerosis include: Fatigue, mood problems, spasticity, bowel, bladder dysfunction, cognitive impairment, eye movement problems, heat sensitivity, incoordination, pain, sexual dysfunction, sleep disorder, vertigo, and visual loss.
History and Symptoms
History
Patients with Multiple sclerosis may have a positive history of:
- African Americans, Mexicans, Japanese, Chinese and Filipinos ethnic [10]
- high titer of EBV antibodies[11][12]
NOTE: McDonald criteria for a MS attack is a symptom cause by demyelinating event in theCNS, lasting more than 24 hours. There should be no fever or sign of infection.[13] First common symptoms of MS disease are optic neuritis, diplopia, sensory or motor loss, vertigo, and balance problems. In young adult eye and sensory problems are prominent while in older patients we see motor problems more often.[14]
Common Symptoms
The most common symptoms of multiple sclerosis include:
- Fatigue: Fatigue is seen in almost 80% of MS patients. They commonly feel exhausted and out of energy. We can see fatigue exacerbation before acute attacks in MS and for a while after that.[15] The etiology of this symptom is poorly understood.[16]
- Mood problems: Psychiatric disorders, especially depression, is common and can be seen in almost 50% of MS patients.[17] Some studies show higher risk of suicide in MS patients.[18][19]
- Spasticity: Damage to the upper motor neurons and decrease inhibition of lower motor neurons in MS can increase muscle tone and rigidity in 75% of MS patients.[20]
- Bowel and bladder dysfunction: Bowel and bladder dysfunction is common in MS patients and occurs in more than 50% of patients.[21] Bladder dysfunction can be the result of Detrusor overactivity, Detrusor sphincter dyssynergia, Inefficient bladder contractility and Abnormal sensation and bladder hypoactivity.[22] the most common bowel problems include Constipation, poor defecation and incontinence.[23]
- Eye movement abnormalities: From more to less common, eye movement problems include abnormalities of voluntary gaze, nystagmus, abnormalities of slow phase eye movements, paroxysmal disorders of eye movements, and isolated ocular motor nerve palsies. These can lead to oscillopsia or diplopia.[24]
- Incoordination: Involvement of cerebellar tracts can cause problems in Gait and balance,l poor coordinated actions, and slurred speech. Intention tremor is present in most of these patients.[25]
- Pain: Pain, a very common symptom in MS patients, can be either from neurogenic source leading to burning or ice-cold dysesthesias or from long immobilization and spasm.[26][27]
- Sexual dysfunction: Sexual dysfunction can be due to involvement of motor and sensory pathways or from psychological problems but either way, it’s a very common symptom. In women we can see reduced libido and orgasm, dyspareunia and decrease vaginal sensation. Presentations of sexual dysfunction in men are decreased libido and premature ejaculation, erectile dysfunction, and reduced penile sensation.[28][29]
- Sleep disorders: Many patients with multiple sclerosis suffer from sleep disorders and daytime somnolence. This can be the result of so many conditions including restless leg syndrome, nocturia, pain and medication side effects. Having more cervical lesions lead to experiencing restless leg syndrome more often.[30][31][32]
- Visual loss: Optic neuritis is the most common eye involvement and presents as an acute unilateral eye pain, followed by some degree of vision loss.[33]
Less Common Symptoms
- Heat sensitivity: Patients with MS disease are more sensitive to heat. A slight increase in body temperature of these patients will lead to worsening of their signs and symptomss.[34]
- Cognitive impairment: Cognitive disorders is common in MS patients and can even present at early stages of disease. These disorders are in attention, short term memory, and information processing. Relapsing-remitting type of MS seems to have lower cognitive problems.[35][36][37][38]
- Vertigo: Benign positional paroxysmal vertigo is the most common cause of vertigo in MS patients. In the course of the disease, about 30-50% of patients experience this symptom.[39]
References
- ↑
- ↑ Hernán MA, Olek MJ, Ascherio A (July 2001). "Cigarette smoking and incidence of multiple sclerosis". Am. J. Epidemiol. 154 (1): 69–74. PMID 11427406.
- ↑ Robertson NP, Fraser M, Deans J, Clayton D, Walker N, Compston DA (April 1996). "Age-adjusted recurrence risks for relatives of patients with multiple sclerosis". Brain. 119 ( Pt 2): 449–55. PMID 8800940.
- ↑ Sadovnick AD, Baird PA, Ward RH (March 1988). "Multiple sclerosis: updated risks for relatives". Am. J. Med. Genet. 29 (3): 533–41. doi:10.1002/ajmg.1320290310. PMID 3376997.
- ↑ Orton SM, Herrera BM, Yee IM, Valdar W, Ramagopalan SV, Sadovnick AD, Ebers GC (November 2006). "Sex ratio of multiple sclerosis in Canada: a longitudinal study". Lancet Neurol. 5 (11): 932–6. doi:10.1016/S1474-4422(06)70581-6. PMID 17052660.
- ↑ Whitacre CC (September 2001). "Sex differences in autoimmune disease". Nat. Immunol. 2 (9): 777–80. doi:10.1038/ni0901-777. PMID 11526384.
- ↑ van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Simmons R, Taylor BV, Butzkueven H, Kilpatrick T (August 2003). "Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study". BMJ. 327 (7410): 316. doi:10.1136/bmj.327.7410.316. PMC 169645. PMID 12907484.
- ↑ Munger KL, Zhang SM, O'Reilly E, Hernán MA, Olek MJ, Willett WC, Ascherio A (January 2004). "Vitamin D intake and incidence of multiple sclerosis". Neurology. 62 (1): 60–5. PMID 14718698.
- ↑ Goodin DS, Ebers GC, Johnson KP, Rodriguez M, Sibley WA, Wolinsky JS (June 1999). "The relationship of MS to physical trauma and psychological stress: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology. 52 (9): 1737–45. PMID 10371517.
- ↑
- ↑
- ↑ Levin LI, Munger KL, Rubertone MV, Peck CA, Lennette ET, Spiegelman D, Ascherio A (May 2005). "Temporal relationship between elevation of epstein-barr virus antibody titers and initial onset of neurological symptoms in multiple sclerosis". JAMA. 293 (20): 2496–500. doi:10.1001/jama.293.20.2496. PMID 15914750.
- ↑ Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O'Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (February 2011). "Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria". Ann. Neurol. 69 (2): 292–302. doi:10.1002/ana.22366. PMC 3084507. PMID 21387374.
- ↑ Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC (February 1989). "The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability". Brain. 112 ( Pt 1): 133–46. PMID 2917275.
- ↑ Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P (April 2015). "Sleep disorders in patients with multiple sclerosis". J Clin Sleep Med. 11 (5): 553–7. doi:10.5664/jcsm.4702. PMC 4410929. PMID 25700869.
- ↑ Krupp L (August 2006). "Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease". Mult. Scler. 12 (4): 367–8. doi:10.1191/135248506ms1373ed. PMID 16900749.
- ↑ Sadovnick AD, Remick RA, Allen J, Swartz E, Yee IM, Eisen K, Farquhar R, Hashimoto SA, Hooge J, Kastrukoff LF, Morrison W, Nelson J, Oger J, Paty DW (March 1996). "Depression and multiple sclerosis". Neurology. 46 (3): 628–32. PMID 8618657.
- ↑ Sadovnick AD, Eisen K, Ebers GC, Paty DW (August 1991). "Cause of death in patients attending multiple sclerosis clinics". Neurology. 41 (8): 1193–6. PMID 1866003.
- ↑ Stenager EN, Stenager E (December 1992). "Suicide and patients with neurologic diseases. Methodologic problems". Arch. Neurol. 49 (12): 1296–303. PMID 1449409.
- ↑ Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
- ↑ DasGupta R, Fowler CJ (2003). "Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies". Drugs. 63 (2): 153–66. PMID 12515563.
- ↑ Wintner A, Kim MM, Bechis SK, Kreydin EI (April 2016). "Voiding Dysfunction in Multiple Sclerosis". Semin Neurol. 36 (2): 219–20. doi:10.1055/s-0036-1582255. PMID 27116728.
- ↑ Hennessey A, Robertson NP, Swingler R, Compston DA (November 1999). "Urinary, faecal and sexual dysfunction in patients with multiple sclerosis". J. Neurol. 246 (11): 1027–32. PMID 10631634.
- ↑ Frohman EM, Frohman TC, Zee DS, McColl R, Galetta S (February 2005). "The neuro-ophthalmology of multiple sclerosis". Lancet Neurol. 4 (2): 111–21. doi:10.1016/S1474-4422(05)00992-0. PMID 15664543.
- ↑ Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
- ↑ Drulovic J, Basic-Kes V, Grgic S, Vojinovic S, Dincic E, Toncev G, Kezic MG, Kisic-Tepavcevic D, Dujmovic I, Mesaros S, Miletic-Drakulic S, Pekmezovic T (August 2015). "The Prevalence of Pain in Adults with Multiple Sclerosis: A Multicenter Cross-Sectional Survey". Pain Med. 16 (8): 1597–602. doi:10.1111/pme.12731. PMID 26087108.
- ↑ Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT (May 2013). "Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis". Pain. 154 (5): 632–42. doi:10.1016/j.pain.2012.12.002. PMID 23318126.
- ↑ Lew-Starowicz M, Gianotten WL (2015). "Sexual dysfunction in patients with multiple sclerosis". Handb Clin Neurol. 130: 357–70. doi:10.1016/B978-0-444-63247-0.00020-1. PMID 26003254.
- ↑ Zivadinov R, Zorzon M, Bosco A, Bragadin LM, Moretti R, Bonfigli L, Iona LG, Cazzato G (December 1999). "Sexual dysfunction in multiple sclerosis: II. Correlation analysis". Mult. Scler. 5 (6): 428–31. doi:10.1177/135245859900500i610. PMID 10618700.
- ↑ Manconi M, Rocca MA, Ferini-Strambi L, Tortorella P, Agosta F, Comi G, Filippi M (January 2008). "Restless legs syndrome is a common finding in multiple sclerosis and correlates with cervical cord damage". Mult. Scler. 14 (1): 86–93. doi:10.1177/1352458507080734. PMID 17942519.
- ↑ Amarenco G, Kerdraon J, Denys P (December 1995). "[Bladder and sphincter disorders in multiple sclerosis. Clinical, urodynamic and neurophysiological study of 225 cases]". Rev. Neurol. (Paris) (in French). 151 (12): 722–30. PMID 8787103.
- ↑ Schürks M, Bussfeld P (April 2013). "Multiple sclerosis and restless legs syndrome: a systematic review and meta-analysis". Eur. J. Neurol. 20 (4): 605–15. doi:10.1111/j.1468-1331.2012.03873.x. PMID 23078359.
- ↑ Balcer LJ (March 2006). "Clinical practice. Optic neuritis". N. Engl. J. Med. 354 (12): 1273–80. doi:10.1056/NEJMcp053247. PMID 16554529.
- ↑ Selhorst JB, Saul RF (June 1995). "Uhthoff and his symptom". J Neuroophthalmol. 15 (2): 63–9. PMID 7550931.
- ↑ Achiron A, Barak Y (April 2003). "Cognitive impairment in probable multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 74 (4): 443–6. PMC 1738365. PMID 12640060.
- ↑ Deloire MS, Salort E, Bonnet M, Arimone Y, Boudineau M, Amieva H, Barroso B, Ouallet JC, Pachai C, Galliaud E, Petry KG, Dousset V, Fabrigoule C, Brochet B (April 2005). "Cognitive impairment as marker of diffuse brain abnormalities in early relapsing remitting multiple sclerosis". J. Neurol. Neurosurg. Psychiatry. 76 (4): 519–26. doi:10.1136/jnnp.2004.045872. PMC 1739602. PMID 15774439.
- ↑ Rao SM, Leo GJ, Bernardin L, Unverzagt F (May 1991). "Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction". Neurology. 41 (5): 685–91. PMID 2027484.
- ↑ Huijbregts SC, Kalkers NF, de Sonneville LM, de Groot V, Reuling IE, Polman CH (July 2004). "Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS". Neurology. 63 (2): 335–9. PMID 15277630.
- ↑ Frohman EM, Zhang H, Dewey RB, Hawker KS, Racke MK, Frohman TC (November 2000). "Vertigo in MS: utility of positional and particle repositioning maneuvers". Neurology. 55 (10): 1566–9. PMID 11094117.