Editing Multiple sclerosis (section)

== Signs and symptoms ==
{{Main|Multiple sclerosis signs and symptoms}}
[[File:Symptoms of multiple sclerosis.svg|thumb|Main symptoms of multiple sclerosis]]

MS lesions can affect any part of the [[central nervous system]] so a person with MS can have almost any [[neurological]] signs or symptoms.<ref>{{Cite web |title=MS Symptoms and Signs of MS {{!}} MS Society |url=https://www.mssociety.org.uk/about-ms/signs-and-symptoms |access-date=2025-02-25 |website=www.mssociety.org.uk |language=en}}</ref>

[[Fatigue]] is one of the most common symptoms of MS.<ref>{{Cite web | url = https://mstrust.org.uk/a-z/fatigue | title = Fatigue | location = Letchworth Garden City, United Kingdom | publisher = Multiple Sclerosis Trust | access-date = 16 January 2024 | archive-date = 16 January 2024 | archive-url = https://web.archive.org/web/20240116234819/https://mstrust.org.uk/a-z/fatigue | url-status = live }}</ref><ref>{{cite journal | vauthors = Moore H, Nair KP, Baster K, Middleton R, Paling D, Sharrack B | title = Fatigue in multiple sclerosis: A UK MS-register based study | journal = Multiple Sclerosis and Related Disorders | volume = 64 | pages = 103954 | date = August 2022 | pmid = 35716477 | doi = 10.1016/j.msard.2022.103954 }}</ref> Roughly 65% of people with MS experience fatigue.  Of these, some 15–40% report fatigue as their most disabling symptom.<ref name="pmid37602098">{{cite journal | vauthors = Bakalidou D, Giannopapas V, Giannopoulos S | title = Thoughts on Fatigue in Multiple Sclerosis Patients | journal = Cureus | volume = 15 | issue = 7 | pages = e42146 | date = July 2023 | pmid = 37602098 | pmc = 10438195 | doi = 10.7759/cureus.42146 | doi-access = free }}</ref>

[[Autonomic nervous system|Autonomic]], visual, motor, and sensory problems are also among the most common symptoms.<ref name="pmid1897097722"/>

The specific symptoms depend on the locations of the lesions within the nervous system and may include [[Hypoesthesia|loss of sensitivity]] or [[Paresthesia|changes in sensation]] in the limbs, such as tingling, “pins and needles,” or numbness; limb motor weakness or pain, [[blurred vision]],<ref>{{cite web |title=MS Signs |url=http://www.webmd.com/multiple-sclerosis/ |url-status=live |archive-url=https://web.archive.org/web/20160930181511/http://www.webmd.com/multiple-sclerosis/ |archive-date=30 September 2016 |access-date=7 October 2016 |website=[[Webmd]]}}</ref> [[Clonus|pronounced reflexes]], [[muscle spasms]], difficulty walking, or with coordination or balance ([[ataxia]]); [[Dysarthria|problems with speech]]<ref>{{cite journal | vauthors = Plotas P, Nanousi V, Kantanis A, Tsiamaki E, Papadopoulos A, Tsapara A, Glyka A, Mani E, Roumelioti F, Strataki G, Fragkou G, Mavreli K, Ziouli N, Trimmis N | title = Speech deficits in multiple sclerosis: a narrative review of the existing literature | journal = European Journal of Medical Research | volume = 28 | issue = 1 | pages = 252 | date = July 2023 | pmid = 37488623 | pmc = 10364432 | doi = 10.1186/s40001-023-01230-3 | doi-access = free }}</ref> or [[Dysphagia|swallowing]], visual problems ([[optic neuritis]] manifesting as eye pain & vision loss,<ref name="Petzold_2022">{{cite journal | vauthors = Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, Andris C, Asgari N, Barnett Y, Battistella R, Behbehani R, Berger T, Bikbov MM, Biotti D, Biousse V, Boschi A, Brazdil M, Brezhnev A, Calabresi PA, Cordonnier M, Costello F, Cruz FM, Cunha LP, Daoudi S, Deschamps R, de Seze J, Diem R, Etemadifar M, Flores-Rivera J, Fonseca P, Frederiksen J, Frohman E, Frohman T, Tilikete CF, Fujihara K, Gálvez A, Gouider R, Gracia F, Grigoriadis N, Guajardo JM, Habek M, Hawlina M, Martínez-Lapiscina EH, Hooker J, Hor JY, Howlett W, Huang-Link Y, Idrissova Z, Illes Z, Jancic J, Jindahra P, Karussis D, Kerty E, Kim HJ, Lagrèze W, Leocani L, Levin N, Liskova P, Liu Y, Maiga Y, Marignier R, McGuigan C, Meira D, Merle H, Monteiro ML, Moodley A, Moura F, Muñoz S, Mustafa S, Nakashima I, Noval S, Oehninger C, Ogun O, Omoti A, Pandit L, Paul F, Rebolleda G, Reddel S, Rejdak K, Rejdak R, Rodriguez-Morales AJ, Rougier MB, Sa MJ, Sanchez-Dalmau B, Saylor D, Shatriah I, Siva A, Stiebel-Kalish H, Szatmary G, Ta L, Tenembaum S, Tran H, Trufanov Y, van Pesch V, Wang AG, Wattjes MP, Willoughby E, Zakaria M, Zvornicanin J, Balcer L, Plant GT | title = Diagnosis and classification of optic neuritis | journal = The Lancet. Neurology | volume = 21 | issue = 12 | pages = 1120–1134 | date = December 2022 | pmid = 36179757 | doi = 10.1016/s1474-4422(22)00200-9 | doi-access = free }}</ref> or [[nystagmus]] manifesting as [[Diplopia|double vision]]), fatigue, and bladder and [[neurogenic bowel dysfunction|bowel difficulties]] (such as urinary or fecal incontinence or retention), among others.<ref name="pmid1897097722"/> When MS is more advanced, walking difficulties lead to a higher risk of falling.<ref>{{cite book |vauthors=Cameron MH, Nilsagard Y |chapter=Balance, gait, and falls in multiple sclerosis | veditors = Day BL, Lord SR |title=Balance, Gait, and Falls  |year=2018 |isbn=978-0-444-63916-5 |series=Handbook of Clinical Neurology |volume=159 |pages=237–250 |doi=10.1016/b978-0-444-63916-5.00015-x |pmid=30482317}}</ref><ref name="McGinley_2021" /><ref>{{cite journal | vauthors = Ghasemi N, Razavi S, Nikzad E | title = Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy | journal = Cell Journal | volume = 19 | issue = 1 | pages = 1–10 | date = January 2017 | pmid = 28367411 | pmc = 5241505 | doi = 10.22074/cellj.2016.4867 | doi-broken-date = 11 November 2024 }}</ref>

Difficulties in thinking and emotional problems such as depression or [[labile affect|unstable mood]] are also common.<ref name="pmid1897097722"/><ref>{{cite journal | vauthors = Chen MH, Wylie GR, Sandroff BM, Dacosta-Aguayo R, DeLuca J, Genova HM | title = Neural mechanisms underlying state mental fatigue in multiple sclerosis: a pilot study | journal = Journal of Neurology | volume = 267 | issue = 8 | pages = 2372–2382 | date = August 2020 | pmid = 32350648 | doi = 10.1007/s00415-020-09853-w }}</ref> The primary deficit in cognitive function that people with MS experience is slowed information-processing speed, with memory also commonly affected, and [[Executive functions|executive function]] less commonly. Intelligence, language, and [[semantic memory]] are usually preserved, and the level of cognitive impairment varies considerably between people with MS.<ref>{{cite journal | vauthors = Oreja-Guevara C, Ayuso Blanco T, Brieva Ruiz L, Hernández Pérez MÁ, Meca-Lallana V, Ramió-Torrentà L | title = Cognitive Dysfunctions and Assessments in Multiple Sclerosis | journal = Frontiers in Neurology | volume = 10 | pages = 581 | date = 2019 | pmid = 31214113 | pmc = 6558141 | doi = 10.3389/fneur.2019.00581 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Kalb R, Beier M, Benedict RH, Charvet L, Costello K, Feinstein A, Gingold J, Goverover Y, Halper J, Harris C, Kostich L, Krupp L, Lathi E, LaRocca N, Thrower B, DeLuca J | title = Recommendations for cognitive screening and management in multiple sclerosis care | journal = Multiple Sclerosis | volume = 24 | issue = 13 | pages = 1665–1680 | date = November 2018 | pmid = 30303036 | pmc = 6238181 | doi = 10.1177/1352458518803785 }}</ref><ref>{{cite journal | vauthors = Benedict RH, Amato MP, DeLuca J, Geurts JJ | title = Cognitive impairment in multiple sclerosis: clinical management, MRI, and therapeutic avenues | language = English | journal = The Lancet. Neurology | volume = 19 | issue = 10 | pages = 860–871 | date = October 2020 | pmid = 32949546 | doi = 10.1016/S1474-4422(20)30277-5 | pmc = 10011205 | s2cid = 221744328 }}</ref>

[[Uhthoff's phenomenon]], a reversible exacerbation of patient symptoms following a rise in body temperature, and [[Lhermitte's sign]], an electrical sensation that runs down the back when flexing the neck, are particularly characteristic of MS, although may not always be present.<ref name="pmid1897097722"/> Another presenting manifestation that is rare but highly suggestive of a demyelinating process such as MS is bilateral [[internuclear ophthalmoplegia]], where the patient experiences double vision when attempting to move their gaze to the right & left.<ref>{{cite journal | vauthors = Zainal Abidin N, Tuan Jaffar TN, Ahmad Tajudin LS | title = Wall-Eyed Bilateral Internuclear Ophthalmoplegia as an Early Presentation of Multiple Sclerosis | journal = Cureus | volume = 15 | issue = 3 | pages = e36835 | date = March 2023 | pmid = 37123672 | pmc = 10147486 | doi = 10.7759/cureus.36835 | doi-access = free }}</ref>

Some 60% or more of MS patients find their symptoms, particularly including fatigue,<ref name="Multiple Sclerosis Trust">{{Cite web | url = https://mstrust.org.uk/news/hot-and-bothered-heat-sensitivity-ms | title = Hot and bothered: how heat makes MS symptoms worse | location = Letchworth Garden City, United Kingdom | publisher = Multiple Sclerosis Trust | access-date = 17 January 2024 | archive-date = 17 January 2024 | archive-url = https://web.archive.org/web/20240117003924/https://mstrust.org.uk/news/hot-and-bothered-heat-sensitivity-ms | url-status = live }}</ref> are affected by changes in body temperature.<ref name="Christogianni-2018">{{cite journal | vauthors = Christogianni A, Bibb R, Davis SL, Jay O, Barnett M, Evangelou N, Filingeri D | title = Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms | journal = Temperature | volume = 5 | issue = 3 | pages = 208–223 | date = 17 January 2018 | pmid = 30377640 | pmc = 6205043 | doi = 10.1080/23328940.2018.1475831 }}</ref><ref name="Heat Sensitivity">{{Cite web|url=https://www.msaustralia.org.au/symptom/heat-sensitivity/|title=Heat Sensitivity|access-date=17 January 2024|archive-date=17 January 2024|archive-url=https://web.archive.org/web/20240117003926/https://www.msaustralia.org.au/symptom/heat-sensitivity/|url-status=live}}</ref><ref name="Multiple Sclerosis Trust-2">{{cite web | url = https://mstrust.org.uk/a-z/temperature-sensitivity | title = Temperature sensitivity | location = Letchworth Garden City, United Kingdom | publisher = Multiple Sclerosis Trust | access-date = 17 January 2024 | archive-date = 17 January 2024 | archive-url = https://web.archive.org/web/20240117003924/https://mstrust.org.uk/a-z/temperature-sensitivity | url-status = live }}</ref>

===Measures of disability===
The main measure of disability and severity is the [[expanded disability status scale]] (EDSS), with other measures such as the [[multiple sclerosis functional composite]] being increasingly used in research.<ref>{{cite journal | vauthors = Kurtzke JF | author-link=John F. Kurtzke | title = Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) | journal = Neurology | volume = 33 | issue = 11 | pages = 1444–52 | date = November 1983 | pmid = 6685237 | doi = 10.1212/WNL.33.11.1444 | doi-access = free }}</ref><ref name="pmid10467378">{{cite journal | vauthors = Amato MP, Ponziani G | title = Quantification of impairment in MS: discussion of the scales in use | journal = Multiple Sclerosis | volume = 5 | issue = 4 | pages = 216–9 | date = August 1999 | pmid = 10467378 | doi = 10.1177/135245859900500404 | s2cid = 6763447 }}</ref><ref name="pmid12356200">{{cite journal | vauthors = Rudick RA, Cutter G, Reingold S | title = The multiple sclerosis functional composite: a new clinical outcome measure for multiple sderosis trials | journal = Multiple Sclerosis | volume = 8 | issue = 5 | pages = 359–65 | date = October 2002 | pmid = 12356200 | doi = 10.1191/1352458502ms845oa | s2cid = 31529508 }}</ref> EDSS is also correlated with falls in people with MS.<ref name="Piryonesi-2021" /> While it is a popular measure, EDSS has been criticized for some of its limitations, such as overreliance on walking.<ref>{{cite journal | vauthors = van Munster CE, Uitdehaag BM | title = Outcome Measures in Clinical Trials for Multiple Sclerosis | journal = CNS Drugs | volume = 31 | issue = 3 | pages = 217–236 | date = March 2017 | pmid = 28185158 | pmc = 5336539 | doi = 10.1007/s40263-017-0412-5 }}</ref><ref name="Piryonesi-2021" />