“Falling is a common symptom of MS. This video will discuss the causes of falling in MS patients, including muscle weakness, spasticity, incoordination, vision, and cognitive problems. We will also explore the importance of early detection and treatment and the role of physical therapy and other interventions in preventing falls.”
Terri wears a tie to promote MS awareness
Multiple sclerosis (MS) can cause a wide range of symptoms and can affect any part of the body. Each person with the condition is affected differently.
The symptoms are unpredictable. Some people’s symptoms develop and worsen steadily over time, while for others they come and go.
Periods when symptoms get worse are known as “relapses”. Periods when symptoms improve or disappear are known as “remissions”.
Some of the most common symptoms include:
vision problems
numbness and tingling
muscle spasms, stiffness and weakness
mobility problems
problems with thinking, learning and planning
depression and anxiety
sexual problems
bowel problems
speech and swallowing difficulties
Most people with MS only have a few of these symptoms.
See your GP if you’re worried you might have early signs of MS. The symptoms can be similar to several other conditions, so they’re not necessarily caused by MS.
Read more about diagnosing MS.
Feeling fatigued is one of the most common and troublesome symptoms of MS.
It’s often described as an overwhelming sense of exhaustion that means it’s a struggle to carry out even the simplest activities.
Fatigue can significantly interfere with your daily activities and tends to get worse towards the end of each day, in hot weather, after exercising, or during illness.
In around one in four cases of MS, the first noticeable symptom is a problem with one of your eyes (optic neuritis). You may experience:
some temporary loss of vision in the affected eye, usually lasting for days to weeks
eye pain, which is usually worse when moving the eye
flashes of light when moving the eye
Other problems that can occur in the eyes include:
involuntary eye movements, which can make it seem as though stationary objects are jumping around
Occasionally, both of your eyes may be affected.
Abnormal sensations can be a common initial symptom of MS.
This often takes the form of numbness or tingling in different parts of your body, such as the arms, legs or trunk, which typically spreads out over a few days.
MS can cause your muscles to:
contract tightly and painfully (spasm)
become stiff and resistant to movement (spasticity)
feel weak
MS can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity (see above). You may experience:
clumsiness
difficulty with balance and co-ordination (ataxia)
shaking of the limbs (tremor)
dizziness and vertigo, which can make it feel as though everything around you is spinning
Some people with MS experience pain, which can take two forms:
Pain caused by MS itself (neuropathic pain) – this is pain caused by damage to the nervous system. This may include stabbing pains in the face and a variety of sensations in the trunk and limbs, including feelings of burning, pins and needles, hugging or squeezing. Muscle spasms can sometimes be painful.
Musculoskeletal pain – back, neck and joint pain can be indirectly caused by MS, particularly for people who have problems walking or moving around that puts pressure on their lower back or hips.
Some people with MS have problems with thinking, learning and planning – known as cognitive dysfunction. This can include:
problems learning and remembering new things – long-term memory is usually unaffected
slowness in processing lots of information or multi-tasking
a shortened attention span
getting stuck on words
problems with understanding and processing visual information, such as reading a map
difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp how to do it
problems with reasoning, such as mathematical laws or solving puzzles
However, many of these problems aren’t specific to MS and can be caused by a wide range of other conditions, including depression and anxiety, or even some medications.
Many people with MS experience periods of depression. It’s unclear whether this is directly caused by MS, or is due to the stress of having to live with a long-term condition, or both.
Anxiety can also be a problem for people with MS, possibly due to the unpredictable nature of the condition.
In rare cases, people with MS can experience rapid and severe mood swings, suddenly bursting into tears, laughing or shouting angrily for no apparent reason.
MS can have an effect on sexual function.
Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.
For women, problems include difficulty reaching orgasm, as well as decreased vaginal lubrication and sensation.
Both men and women with MS may find they are less interested in sex than they were before. This could be directly related to MS, or it could be the result of living with the condition.
Bladder problems are common in MS. They may include:
having to pee more frequently
having a sudden, urgent need to pee, which can lead to unintentionally passing urine (urge incontinence)
difficulty emptying the bladder completely
having to get up frequently during the night to pee
recurrent urinary tract infections
These problems can also have a range of causes other than MS.
Many people with MS also have problems with their bowel function.
Constipation is the most common problem. You may find passing stools difficult and pass them much less frequently than normal.
Bowel incontinence is less common, but is often linked to constipation. If a stool becomes stuck, it can irritate the wall of the bowel, causing it to produce more fluid and mucus that can leak out of your bottom.
Again, some of these problems aren’t specific to MS and can even be the result of medications, such as medicines prescribed for pain.
Some people with MS experience difficulty chewing or swallowing (dysphagia) at some point.
Speech may also become slurred, or difficult to understand (dysarthria).
A double-blind, randomized, placebo-controlled trial by MS researchers at Kessler Foundation shows significant improvement in processing speed following a five-week, 10-session training intervention; treatment effect maintained at six-month follow-up
Experts at Kessler Foundation reported the results of a randomized controlled trial to target deficits of processing speed in persons with multiple sclerosis (MS) and showed improvement through the application of speed-of-processing training.
Their article, “The efficacy of speed of processing training for improving processing speed in individuals with multiple sclerosis: A randomized clinical trial,” (doi: 10.1007/s00415-022-10980-9) was published online February 12, 2022, in Journal of Neurology. (https://tinyurl.com/5d9ykvtv). The authors are Nancy D. Chiaravalloti, PhD, Silvana L. Costa, PhD, Nancy B. Moore, MA, Kristen Costanza, and John DeLuca, PhD, of Kessler Foundation.
Cognitive dysfunction affects as many as 70% of people with MS. The most common deficit in cognitive function impacts processing speed, which adversely affects performance of tasks of daily living, including household chores, driving, and using public transportation, and contributes to the high employment among people with MS. Effective ways to improve processing speed in this population have the potential to enhance outcomes.
A total of 84 individuals with MS and impaired processing speed were randomized to treatment or placebo groups; final data analyses were based on 71 participants (Treatment, 37; Placebo, 34). All participants underwent neuropsychological evaluation and assessment of everyday cognitive function at baseline and at follow up immediately after the five-week, 10-session speed-of-processing training, and again six months later.
“We saw significant improvement in processing speed in the treatment group,” said Dr. Chiaravalloti, director of the Centers for Neuropsychology, Neuroscience, and Traumatic Brain Injury Research. “Moreover, we found that treatment dosage correlated with improvement. That is, participants who completed more levels within each training task showed greater benefits.”
“Another important finding was the sustained benefit at the six-month follow up,” noted Dr. Chiaravalloti, “regardless of whether the person received booster sessions. Future research is needed to evaluate long-term efficacy of speed-of-processing training in people with different subtypes of MS, including progressive MS.”
Dr. DeLuca, an expert in cognitive rehabilitation research, is senior vice president for Research and Training at Kessler Foundation. He is professor of Neurology and Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School, and president-elect of the National Academy of Neuropsychology. Kessler Foundation
Experts in cognitive research evaluated the status of available treatments as well as promising strategies for treating cognitive deficits in multiple sclerosis. The article, “Treatment and management of cognitive dysfunction in patients with multiple sclerosis”, was published in Nature Reviews 2020 May 05. (doi: 10.1038/s41582-020-0355-1) The authors are John DeLuca, PhD, and Nancy Chiaravalloti, PhD, of Kessler Foundation, and Brian Sandroff, PhD, of the University of Alabama at Birmingham.
Cognitive dysfunction is a common, disabling symptom of multiple sclerosis, affecting two-thirds of patients. These individuals can have difficulties managing finances, performing household tasks, and functioning in the community and the workplace. Although the impact on daily life may be profound, the diagnosis and management of cognitive dysfunction in this population remains inadequate. The authors provided detailed analyses of different approaches to treatment, including cognitive rehabilitation, exercise training, and pharmacotherapy, and the important contributions of brain neuroimaging to advances in this field.
Over the past decade, research activity in cognitive rehabilitation has increased in the population with MS. There is greater emphasis on cognitive screening and assessment, and some standardized treatment protocols are available. “Evidence suggests that cognitive rehabilitation is effective in MS-related cognitive dysfunction, and may confer long-lasting effects,” said John DeLuca, PhD, senior VP of Research and Training at Kessler Foundation, and a co-author of the article. “Access to cognitive rehabilitation therapy is likely to increase as remote options for delivery become more widely accepted, such as programs for home computers and telerehabilitation services.”
Exercise training is an active area of MS research that shows promise for enhancing cognitive function and effecting positive change in the everyday lives of people living with MS. With improvements in methodology, this line of research will support consideration of exercise as the standard of care for individuals with MS. “It is critical that larger scale studies include participants with MS, including progressive MS, and target select cognitive outcomes,” Dr. DeLuca noted. To develop treatment protocols, the timing, dosage and duration of exercise need to be determined. “As studies continue to evolve, clinical applications of exercise recommendations are likely to be implemented within the next ten years,” he predicted.
The authors found that current pharmacotherapeutic approaches were of limited benefit for the cognitive symptoms of MS. To date, none of the available medications or disease-modifying therapies for MS are indicated for the treatment of cognitive deficits. Dr. DeLuca addressed the fundamental challenge to trials of pharmaceutical agents: “To determine the efficacy of a pharmacologic intervention for cognitive dysfunction, randomized controlled trials need to include cognition among their primary outcomes.”
