Symptoms are the complaints that you bring to your doctor's office and signs are the clues your doctor discovers through examination. Together, symptoms and signs are termed findings. It is the role of the physician to find physical signs that substantiate a patient's complaints or symptoms, but symptoms can exist in the absence of signs. You may have tingling or numbness in your hand that your doctor can't substantiate on examination. Other times, your doctor may find signs upon neurological examination for which you are not experiencing symptoms. You may have optic neuritis (inflammation of the optic nerve), and not note any visual difficulties.

The symptoms of MS include fatigue, weakness, numbness, cognitive difficulties, clumsiness of fine motor coordination, and bowel or bladder problems, to name a few.

MS symptoms generally appear between the ages of twenty and forty. The onset of MS may be dramatic or so mild that a person doesn't even notice any symptoms until later in the course of the disease.

As you learned in Chapter 1, disruption of communication between the brain and other parts of the body prevent normal passage of sensations and messages, leading to the symptoms of MS. The demyelinated areas appear as plaques (or scars). The progression of symptoms in MS is caused by the development of new plaques in the portion of the brain or spinal cord that controls the affected areas. Since there is no evidence that there is any pattern to the development of new plaques, the progression of MS is unpredictable.

In Chapter 9, the symptoms of MS will be fleshed out further. In this chapter, the symptoms most people experience in the beginning stages of the disease will be discussed.

It's very important to remember that you will not experience all of the symptoms that are addressed here.

While most any symptom can appear to signal a problem that may prompt you to call your physician, the most common problems people bring to their doctor's office for the first time include the following:

• Tingling

• Numbness

• Loss of balance

• Weakness in one or more limbs

• Blurred or double vision

Less common first symptoms of MS include slurred speech, weakness, lack of coordination, and cognitive difficulties. As the disease progresses, other symptoms may include muscle spasms, sensitivity to heat, fatigue, changes in thinking or perception, and sexual disturbances.

Most people with MS will experience more than one symptom, and though there are symptoms common to many people, no person will have all of them. The good news is that your doctor can help you keep your symptoms under control.

Some symptoms come and go while others may be permanent. Most people with MS are on very intimate terms with their symptoms and use them as a yardstick to assess their current level of health as it pertains to the disease. For example, if you have overtaxed yourself, an old friend — such as numbness in your hand — may show up to remind you to take it easy for a while. This is sometimes referred to as “fluctuation of a chronic symptom” and is usually not due to new disease activity. In contrast, entirely new symptoms, especially those that are notable enough to interfere with day-to-day functioning, usually indicate that you are experiencing an exacerbation. As a result, you should always report new symptoms to your doctor.