Multiple Sclerosis (MS): Symptoms, Causes & Treatment Guide

What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic autoimmune disease where the immune system mistakenly attacks the myelin sheath—the protective covering around nerve fibers in the central nervous system. This damage disrupts nerve signal transmission between the brain and body, causing a wide range of neurological symptoms that can vary greatly from person to person.

Multiple sclerosis gets its name from the multiple areas of scarring (sclerosis) that develop on the myelin sheath throughout the brain and spinal cord. These scarred areas, also called lesions or plaques, can be detected on MRI scans and are a hallmark of the disease. The location of these lesions determines which symptoms a person experiences, which is why MS can present so differently in different individuals.

The central nervous system consists of the brain and spinal cord, which together serve as the body's control center. Nerve fibers, called axons, transmit electrical signals throughout this system, controlling everything from movement and sensation to cognition and emotions. For these signals to travel efficiently, the nerve fibers need to be insulated by myelin, much like electrical wires are coated with plastic insulation.

When the immune system damages this myelin coating in MS, the electrical signals either slow down, become distorted, or fail to transmit altogether. Initially, the body can sometimes repair this damage, which explains why early symptoms may come and go. However, repeated attacks can lead to permanent nerve damage and accumulating disability over time. This is why early diagnosis and treatment are so important—to prevent as much irreversible damage as possible.

MS is considered a lifelong condition, though its course varies tremendously. Some people have mild disease with few symptoms over decades, while others experience more rapid progression. Modern disease-modifying therapies have dramatically changed the outlook for people with MS, making it possible for most to live full, active lives with proper treatment and management.

How the Nervous System Is Affected

To understand MS, it helps to know how the nervous system works. The central nervous system contains billions of nerve cells (neurons) that communicate through electrical and chemical signals. Each neuron has a long projection called an axon that transmits signals to other neurons. Myelin, produced by cells called oligodendrocytes, wraps around these axons in segments, dramatically speeding up signal transmission.

When MS damages the myelin, several things happen. First, signals slow down because they can no longer "jump" efficiently along the myelinated segments. Second, the exposed nerve fiber becomes vulnerable to further damage. Over time, the axon itself can be damaged or destroyed, leading to permanent loss of function. This progression from myelin damage to axon damage explains why early treatment to reduce inflammation is so critical.

Who Gets Multiple Sclerosis?

MS can affect anyone, but certain patterns emerge when looking at who develops the condition. Women are diagnosed two to three times more often than men, though men who develop MS often have a more progressive form of the disease. The condition most commonly appears between ages 20 and 40, though children and older adults can also be diagnosed.

Geographic distribution shows interesting patterns—MS is more common in countries farther from the equator, including Northern Europe, Canada, and the northern United States. This has led researchers to investigate the role of vitamin D and sunlight exposure in MS risk. People who migrate from low-risk to high-risk areas before age 15 take on the risk of their new location, suggesting early-life environmental factors play a role.

What Are the Different Types of Multiple Sclerosis?

MS is classified into four main types: relapsing-remitting MS (RRMS), which affects about 85% of newly diagnosed patients with alternating attacks and recovery periods; secondary progressive MS (SPMS), which develops from RRMS; primary progressive MS (PPMS), with gradual worsening from onset; and clinically isolated syndrome (CIS), a single episode that may or may not develop into MS.

Relapsing-Remitting MS (RRMS)

The most common form of MS, relapsing-remitting MS, affects approximately 85% of people initially diagnosed with the condition. RRMS is characterized by clearly defined attacks of new or worsening neurological symptoms, called relapses or exacerbations. These relapses can last from days to months and are followed by periods of partial or complete recovery called remissions.

During remissions, the disease doesn't progress, and some or all symptoms may disappear. However, each relapse carries the risk of incomplete recovery, potentially leaving behind some degree of residual symptoms. The frequency of relapses varies widely—some people may have several in a year, while others go years between attacks. Disease-modifying therapies work primarily by reducing the frequency and severity of these relapses.

The unpredictability of RRMS can be one of its most challenging aspects. People never know when the next relapse will occur or what symptoms it might bring. However, this form of MS is also the most responsive to current treatments, making early diagnosis and therapy initiation particularly important.

Secondary Progressive MS (SPMS)

Many people who start with relapsing-remitting MS eventually transition to secondary progressive MS. In this phase, the disease begins to progress more steadily, with gradual worsening of neurological function over time. Relapses may still occur, but the periods between them no longer bring the same degree of recovery.

Before effective disease-modifying therapies became available, approximately 50% of people with RRMS transitioned to SPMS within 10-15 years of diagnosis. Modern treatments appear to delay or prevent this transition in many cases, though research is ongoing. Once SPMS develops, different treatment strategies may be needed, as the disease mechanisms change from predominantly inflammatory to more neurodegenerative.

Primary Progressive MS (PPMS)

Approximately 10-15% of people with MS are diagnosed with primary progressive MS. Unlike RRMS, PPMS involves gradual worsening of symptoms from the very beginning, without distinct relapses or remissions. The rate of progression varies—some people experience slow decline over many years, while others progress more rapidly.

PPMS typically develops later in life than RRMS, often appearing in the 40s or 50s. It affects men and women more equally than other forms of MS. Treatment options for PPMS have historically been more limited, though newer therapies have shown benefit. Physical and occupational therapy play especially important roles in managing this form of MS.

Benign MS

Some people with MS experience very mild disease over many years, sometimes called benign MS. These individuals may have had an initial episode or two but then remain stable with minimal or no disability for 15 years or more. However, this diagnosis can only be made in retrospect, looking back at the disease course, and some people initially thought to have benign MS do eventually experience progression.

What Are the Symptoms of Multiple Sclerosis?

MS symptoms vary widely depending on which nerves are affected, but commonly include vision problems (blurred vision, optic neuritis), numbness or tingling in limbs, muscle weakness and spasticity, balance and coordination problems, fatigue (often overwhelming), bladder and bowel dysfunction, cognitive changes, and mood disorders including depression.

The symptoms of multiple sclerosis are remarkably diverse because they depend on the location and extent of nerve damage in the central nervous system. No two people with MS have exactly the same symptoms, and even in the same person, symptoms can change over time. Some symptoms may come and go, while others may persist or gradually worsen.

Understanding MS symptoms is important for several reasons. First, recognizing early symptoms can lead to earlier diagnosis and treatment. Second, understanding symptoms helps people with MS communicate effectively with their healthcare team. Third, knowing what symptoms are possible helps with planning and adaptation.

Vision Problems

Visual symptoms are often among the first signs of MS. Optic neuritis, inflammation of the optic nerve, occurs in about 50% of people with MS at some point and is the first symptom in approximately 15-20% of cases. It typically causes pain with eye movement and vision loss in one eye, which can range from mild blurring to significant impairment. While frightening, vision usually improves substantially over weeks to months.

Other vision problems in MS include double vision (diplopia), caused by weakness in the muscles controlling eye movement, and nystagmus, involuntary rhythmic eye movements. Some people experience partial or complete loss of color vision or visual field defects. These symptoms often improve with treatment but may leave residual effects.

Sensory Symptoms

Numbness, tingling, and other abnormal sensations are extremely common in MS, affecting most people at some point. These symptoms can occur anywhere in the body but often start in one limb and may spread to other areas. The sensations can range from mild pins and needles to complete numbness or unpleasant burning, itching, or painful sensations.

Lhermitte's sign is a distinctive MS symptom—an electrical shock-like sensation that runs down the spine and into the limbs when bending the neck forward. While startling, it's not dangerous and often improves over time. Some people also experience the "MS hug," a tight, band-like sensation around the torso caused by spasms of the small muscles between the ribs.

Motor Symptoms and Mobility

Muscle weakness can affect any part of the body but commonly involves the legs, making walking difficult. The weakness results from damaged nerve signals failing to adequately stimulate muscles. Over time, muscles that aren't being used properly may also become deconditioned, compounding the problem.

Spasticity, or muscle stiffness, occurs when damage to nerves disrupts the normal regulation of muscle tone. Muscles become tight and resistant to stretching, which can cause pain, interfere with movement, and contribute to fatigue. Spasticity can sometimes be helpful—providing stability in a weak leg, for example—but often needs to be managed with medications and physical therapy.

Balance and coordination problems (ataxia) result from damage to the cerebellum or its connections. People may feel unsteady on their feet, have difficulty with precise movements, or experience tremor during voluntary movements. These symptoms can significantly impact daily activities and safety.

Fatigue

Fatigue is one of the most common and disabling symptoms of MS, affecting up to 80% of people with the condition. MS fatigue is different from ordinary tiredness—it's often described as an overwhelming exhaustion that isn't relieved by rest or sleep. It can occur suddenly, often in the afternoon, and significantly impact work, family life, and daily activities.

The causes of MS fatigue are not fully understood but likely involve multiple factors: the extra energy required for damaged nerves to transmit signals, immune system activation, sleep disturbances, depression, and medications. Managing fatigue often requires a combination of approaches including energy conservation, exercise, cooling strategies, and sometimes medications.

Cognitive Changes

Cognitive symptoms affect approximately 40-70% of people with MS and can occur at any stage of the disease. The most common problems involve processing speed, memory (especially recalling recent information), attention, and executive functions like planning and problem-solving. Language skills are typically preserved.

Cognitive changes can be subtle or significant and often cause considerable distress. They may affect work performance, social interactions, and daily functioning. Cognitive rehabilitation, compensatory strategies, and some medications may help. Regular cognitive assessment can detect changes early and guide interventions.

Bladder and Bowel Dysfunction

Bladder problems affect about 80% of people with MS and result from interrupted nerve signals controlling the bladder. Symptoms may include urgency (sudden strong need to urinate), frequency, incontinence, or difficulty emptying the bladder completely. Untreated bladder dysfunction can lead to urinary tract infections, which can trigger MS relapses.

Bowel problems, including constipation and, less commonly, incontinence, also occur frequently. Constipation is particularly common and can result from reduced mobility, medications, or neurogenic bowel dysfunction. Both bladder and bowel problems can often be effectively managed with appropriate strategies and treatments.

Emotional and Psychological Effects

Depression affects approximately 50% of people with MS at some point—much higher than in the general population. This isn't simply a reaction to having a chronic illness; MS itself causes changes in the brain that increase depression risk. Anxiety is also common. Both conditions can worsen other MS symptoms and significantly impact quality of life if untreated.

Some people with MS experience emotional changes such as pseudobulbar affect—sudden, uncontrollable laughing or crying that may not match their actual emotions. This results from damage to areas of the brain that regulate emotional expression and can be particularly distressing. Effective treatments are available.

What Causes Multiple Sclerosis?

The exact cause of MS remains unknown, but it appears to result from a combination of genetic susceptibility, environmental factors (including low vitamin D, smoking, and possibly viral infections like Epstein-Barr virus), and immune system dysfunction. Having a family member with MS increases risk, but most people with MS have no family history of the condition.

Despite decades of research, scientists have not identified a single cause of multiple sclerosis. Instead, evidence suggests that MS develops when certain environmental triggers activate the disease in genetically susceptible individuals. Understanding these risk factors can help with prevention strategies and guides ongoing research toward potential treatments.

Genetic Factors

MS is not directly inherited, but genetic factors clearly play a role. In the general population, the risk of developing MS is approximately 0.1%. However, this risk increases significantly with family history—if a parent or sibling has MS, the risk rises to 2-4%. Identical twins share about 25% risk, while fraternal twins have about 5% risk, similar to other siblings.

Researchers have identified over 200 genetic variants that contribute to MS risk, most involving genes related to immune system function. The strongest genetic association is with certain variants of the HLA-DRB1 gene, part of the immune system's recognition machinery. However, no single gene causes MS—it appears that multiple genetic variants combine to create susceptibility.

Environmental Factors

Several environmental factors have been linked to MS risk. Vitamin D deficiency stands out as one of the most important. People living far from the equator, where there's less sunlight for vitamin D production, have higher MS rates. Low vitamin D levels have been associated with increased MS risk and, in people who have MS, with more relapses and faster progression.

Smoking significantly increases MS risk and accelerates disease progression in those who have it. People who smoke have roughly 1.5 times the risk of developing MS compared to non-smokers. After diagnosis, smoking is associated with faster conversion from RRMS to SPMS. Quitting smoking is one of the most impactful lifestyle changes someone with MS can make.

Obesity, particularly during adolescence, has emerged as another risk factor. Childhood and teenage obesity approximately doubles MS risk. The mechanisms may involve vitamin D (which is sequestered in fat tissue), inflammation associated with obesity, or other metabolic factors.

Viral Infections

Epstein-Barr virus (EBV), the virus that causes infectious mononucleosis, has the strongest viral link to MS. Studies show that nearly 100% of people with MS have been infected with EBV, compared to about 95% of the general population. More importantly, people who've had symptomatic mononucleosis have about twice the MS risk. Recent research has dramatically strengthened this link, with some scientists proposing EBV as a necessary (though not sufficient) cause of MS.

The mechanism may involve molecular mimicry—the immune system learns to attack EBV but then mistakenly attacks similar-looking proteins in myelin. Research into EBV vaccines and antiviral treatments is ongoing, with the hope that preventing or treating EBV infection might prevent some cases of MS.

How Is Multiple Sclerosis Diagnosed?

MS diagnosis uses the McDonald criteria, requiring evidence of damage in at least two separate areas of the central nervous system occurring at different times. Diagnosis typically involves neurological examination, MRI scans of the brain and spinal cord to detect lesions, lumbar puncture to test cerebrospinal fluid for oligoclonal bands, and evoked potential tests to measure nerve conduction speed.

Diagnosing multiple sclerosis can be challenging because symptoms vary widely and can mimic other conditions. There's no single test that definitively diagnoses MS. Instead, neurologists use a combination of clinical evaluation, imaging studies, and sometimes additional tests to establish the diagnosis while ruling out other possibilities.

The diagnostic process often begins when someone experiences symptoms that could be neurological in origin. A detailed history is crucial—when symptoms started, how they've progressed, whether there have been prior episodes that might not have been recognized as MS-related. Family history, lifestyle factors, and geographic background all provide important context.

Neurological Examination

A thorough neurological examination is fundamental to MS diagnosis. The neurologist tests various functions including vision, eye movements, strength, sensation, reflexes, coordination, and gait. Abnormalities in these examinations can reveal evidence of nervous system damage and help localize where in the brain or spinal cord the problem might be.

Specific signs that may suggest MS include abnormal reflexes (either increased or certain primitive reflexes), changes in eye movement coordination, spasticity, and gait abnormalities. However, early MS may show few or no abnormalities on examination, making imaging studies essential.

MRI Scanning

Magnetic resonance imaging (MRI) is the most important diagnostic tool for MS. MRI can detect the lesions (areas of damage) in the brain and spinal cord that characterize the disease. The McDonald criteria specify particular patterns and locations of lesions that support MS diagnosis.

Different MRI sequences provide different information. T2-weighted images show the total burden of disease—all lesions, new and old. FLAIR sequences are particularly sensitive for lesions near the ventricles. T1-weighted images with gadolinium contrast can identify actively inflamed lesions, indicating recent disease activity. The spinal cord should also be imaged, as cord lesions are common in MS and can help distinguish it from other conditions.

MRI findings must be interpreted in clinical context. Some people have MRI findings suggestive of MS but never develop symptoms (radiologically isolated syndrome). Others may have MS with relatively few lesions visible on MRI. The combination of clinical presentation and imaging findings guides diagnosis.

Lumbar Puncture

A lumbar puncture (spinal tap) involves collecting a small amount of cerebrospinal fluid (CSF) from the lower back. This fluid bathes the brain and spinal cord and can reveal information about inflammation and immune activity in the central nervous system.

In MS, the CSF often contains oligoclonal bands—proteins produced by immune cells within the central nervous system that aren't present in the blood. Finding oligoclonal bands supports the diagnosis of MS, though they can also occur in other inflammatory conditions. The CSF is also tested for other markers and to help rule out infections or other conditions.

Evoked Potential Tests

Evoked potential tests measure how quickly nerve signals travel in response to specific stimuli. Visual evoked potentials (VEPs), which measure the time for signals to travel from the eyes to the brain, are most commonly used in MS evaluation. Slowed conduction indicates damage to the optic nerve, even if the person hasn't noticed vision problems.

Other evoked potential tests include somatosensory evoked potentials (testing sensation pathways) and brainstem auditory evoked potentials. These tests can reveal evidence of damage that might not be apparent on MRI or clinical examination.

The McDonald Criteria

The McDonald criteria, most recently updated in 2017, provide a standardized framework for diagnosing MS. The core requirement is demonstrating that damage has occurred in multiple areas of the central nervous system (dissemination in space) at more than one point in time (dissemination in time).

These criteria can now often be met at a single time point if MRI shows both old and new lesions or if CSF shows oligoclonal bands. This allows for earlier diagnosis, which is important because early treatment improves outcomes. However, the criteria also emphasize that other conditions must be adequately ruled out.

How Is Multiple Sclerosis Treated?

MS treatment has three main components: disease-modifying therapies (DMTs) to reduce relapses and slow progression, treatments for acute relapses (typically high-dose corticosteroids), and symptom management for issues like fatigue, spasticity, and bladder problems. More than 20 DMTs are now available, reducing relapses by up to 70% and significantly improving long-term outcomes.

The treatment of multiple sclerosis has been transformed over the past three decades. From having essentially no disease-modifying treatments in the early 1990s, we now have more than 20 approved medications that can significantly alter the course of the disease. Combined with better symptom management and rehabilitation approaches, people with MS today have more treatment options and better outcomes than ever before.

Treatment decisions should be individualized, taking into account the type and activity of MS, the person's preferences and circumstances, and potential side effects and risks. A neurologist specializing in MS can help navigate these complex decisions. Regular monitoring and follow-up are essential to ensure treatments are working and to adjust approaches as needed.

Disease-Modifying Therapies

Disease-modifying therapies (DMTs) work by reducing immune system attacks on the central nervous system. They don't cure MS or reverse existing damage, but they can significantly reduce relapse frequency, slow accumulation of new brain lesions, and delay disability progression. Starting DMTs early in the disease course generally leads to better long-term outcomes.

DMTs vary in their efficacy, mechanisms of action, routes of administration, and side effect profiles. Injectable medications like interferons and glatiramer acetate were the first available and have long safety track records. Oral medications like dimethyl fumarate, fingolimod, and siponimod offer convenience but have their own considerations. Highly effective infusion therapies like natalizumab, ocrelizumab, and alemtuzumab may be appropriate for aggressive disease.

The choice of DMT depends on many factors including disease activity, previous treatments, desire for pregnancy, other health conditions, and personal preferences regarding administration route and monitoring requirements. Some neurologists favor starting with a highly effective therapy, while others prefer a step-up approach. This is an evolving area where new evidence continues to inform practice.

Treating Relapses

When an MS relapse occurs, high-dose corticosteroids are typically the first-line treatment. Usually given as intravenous methylprednisolone for 3-5 days, steroids reduce inflammation and can shorten relapse duration. However, they don't appear to affect the final degree of recovery from a relapse.

Not all relapses require treatment. Mild sensory symptoms that don't significantly impact function may be allowed to resolve on their own. The decision to treat depends on the severity of symptoms, how much they're affecting daily life, and individual circumstances. For severe relapses that don't respond to steroids, plasma exchange (plasmapheresis) may be considered.

Symptom Management

Managing MS symptoms is crucial for quality of life. Fatigue can be addressed through energy conservation strategies, exercise programs, cooling measures, and sometimes medications like amantadine or modafinil. Spasticity may be treated with physical therapy, medications like baclofen or tizanidine, and in severe cases, intrathecal baclofen pumps or botulinum toxin injections.

Bladder symptoms require proper evaluation to determine the type of dysfunction. Treatments range from behavioral modifications and pelvic floor exercises to medications and, if needed, catheterization. Pain, depression, cognitive problems, and other symptoms each have specific management approaches. A multidisciplinary team including neurologists, nurses, physical therapists, occupational therapists, and other specialists provides comprehensive care.

Rehabilitation

Physical therapy and rehabilitation play essential roles in MS management. Regular exercise has been shown to improve strength, endurance, mobility, and quality of life, and may even have neuroprotective effects. Physical therapists can design individualized programs appropriate for each person's abilities and limitations.

Occupational therapy helps people adapt daily activities and maintain independence. This might include recommending assistive devices, teaching energy conservation techniques, or suggesting home modifications. Speech therapy can address communication and swallowing problems when they occur.

Stem Cell Transplantation

Autologous hematopoietic stem cell transplantation (AHSCT) is an intensive treatment option for some people with aggressive relapsing MS who haven't responded adequately to conventional DMTs. The procedure involves collecting the person's own stem cells, using chemotherapy to eliminate the existing immune system, then reinfusing the stem cells to rebuild a new immune system.

AHSCT can be highly effective, with many patients becoming relapse-free for years. However, it carries significant risks, including treatment-related mortality, and is only appropriate for carefully selected patients. It's typically available at specialized centers and requires extensive evaluation beforehand.

What Is It Like Living with Multiple Sclerosis?

Living with MS requires ongoing adaptation but most people lead full, productive lives. Key strategies include staying on disease-modifying therapy, managing symptoms proactively, maintaining physical activity, avoiding triggers like heat and infections, building a support network, and working closely with healthcare providers. Career planning, family decisions, and emotional wellbeing all require attention.

A diagnosis of multiple sclerosis is life-changing, but it doesn't have to be life-limiting. With modern treatments and management strategies, many people with MS continue to work, raise families, pursue hobbies, and live fulfilling lives. The key is proactive management, adaptation, and maintaining hope while being realistic about challenges.

Receiving the Diagnosis

Learning you have MS typically triggers a range of emotions—shock, fear, anger, grief, and sometimes relief at finally having an explanation for symptoms. These reactions are normal and expected. It takes time to process the diagnosis and begin adapting. Support from family, friends, healthcare providers, and MS organizations can help during this period.

Education is empowering. Understanding MS, its treatments, and what to expect helps people feel more in control. However, it's important to get information from reliable sources. MS organizations, healthcare providers, and reputable medical websites are better sources than general internet searches, which can lead to outdated or alarming information.

Lifestyle Factors

Several lifestyle factors can influence MS course and symptom management. Heat sensitivity is common—elevated body temperature can temporarily worsen symptoms. Staying cool, especially during exercise or in warm weather, helps manage this. Regular exercise, despite potentially being challenging, has numerous benefits and doesn't trigger disease activity.

Diet and nutrition matter for overall health, though no specific "MS diet" has proven benefits. A balanced diet rich in fruits, vegetables, and omega-3 fatty acids supports general health. Some evidence suggests vitamin D supplementation may be beneficial, especially for those with low levels. Alcohol should be used in moderation as it can interact with medications and worsen symptoms.

Not smoking is one of the most important things someone with MS can do. Smoking accelerates progression, increases disability accumulation, and may reduce the effectiveness of some treatments. Quitting smoking at any point is beneficial.

Work and Career

Many people with MS continue to work for years or even decades after diagnosis. However, cognitive symptoms, fatigue, and physical limitations may eventually affect work capacity. Planning ahead, knowing your rights, and communicating with employers can help navigate work-related challenges.

Many countries have laws protecting employees with disabilities, including MS. Reasonable accommodations might include flexible schedules, the ability to work from home, modified workspaces, or adjusted responsibilities. Vocational rehabilitation services can help with career planning and workplace adaptations.

Family and Relationships

MS affects not just the person diagnosed but the entire family. Partners may take on caregiving roles, and children may worry about their parent or about their own risk of developing MS. Open communication about the disease, its management, and how everyone is coping emotionally strengthens family resilience.

Decisions about having children are deeply personal. MS itself doesn't affect fertility, and pregnancy is safe for most women with MS (indeed, relapses often decrease during pregnancy). However, some medications must be stopped before conception, requiring planning with neurologists. The genetic risk to children is increased but remains relatively small.

Emotional Wellbeing

Depression and anxiety are common in MS and can significantly impact quality of life if untreated. These aren't signs of weakness or failure to cope—they're partly caused by MS itself and are medical conditions deserving treatment. Counseling, support groups, and medications can all help.

Stress management is important as stress may trigger or worsen symptoms, though research on this is mixed. Techniques like mindfulness, meditation, and relaxation can be helpful. Finding meaning and purpose, maintaining social connections, and engaging in enjoyable activities support emotional wellbeing.

When Should You See a Doctor for MS Symptoms?

See a doctor if you experience persistent neurological symptoms such as vision changes, numbness or tingling lasting more than 24 hours, unexplained muscle weakness, balance problems, or unusual fatigue. Seek urgent care for sudden severe symptoms. If you already have MS, contact your neurologist for new or significantly worsening symptoms that might indicate a relapse.

Early diagnosis of MS leads to better outcomes because treatment can begin before significant damage accumulates. If you're experiencing symptoms that might be neurological in origin, it's worth getting evaluated, even if symptoms seem mild or come and go. Your primary care doctor can perform an initial assessment and refer you to a neurologist if needed.

Symptoms That Warrant Medical Evaluation

Seek medical attention if you experience any of the following symptoms, especially if they persist for more than 24 hours or occur repeatedly:

• Vision changes in one eye, especially with pain on eye movement
• Numbness or tingling that doesn't resolve quickly
• Weakness in one or more limbs
• Difficulty with balance or coordination
• Unusual fatigue that doesn't improve with rest
• Electric shock sensations when bending the neck
• Slurred speech or difficulty swallowing
• New bladder or bowel problems

If You Already Have MS

People with established MS should contact their neurologist or MS nurse when experiencing new or significantly worsening symptoms that might represent a relapse. Not every symptom change is a relapse—fatigue, heat, stress, or infections can temporarily worsen existing symptoms (called a pseudo-relapse). However, new symptoms or significant worsening lasting more than 24 hours, in the absence of infection or fever, should be evaluated.

Regular monitoring is important even when feeling well. MRI scans can detect new disease activity before it causes symptoms. Blood tests monitor for medication side effects. Neurological examinations track any subtle changes. Following the recommended follow-up schedule helps ensure MS remains well-controlled.