ten

MS SYMPTOMS TO
KEEP TRACK OF

The big picture

One of the things people with relapsing MS have in common is that they experience the disease differently. The symptoms that appear, and how long those symptoms last, vary from person to person.

Everybody’s different | Relapse & remission | Tips | When to call your doctor Expand this section

Everybody’s different

The type of relapsing multiple sclerosis symptoms and signs you experience may depend on where lesions form. For example, where lesions form in one part of the brain may cause dizziness. Similarly, where lesions form in the spinal cord may cause weakness, while where they form in the optic nerve may cause blurred vision.

While there is no way to know how long a symptom may last or whether it will go away completely or persist, don't be discouraged. You and your doctor can work together to develop a symptom management strategy that may help. Tracking how long your symptoms last and other details will help you create your plan.

Relapse & remission

Relapses are not the same as symptoms. A relapse is an event lasting more than 24 hours, when old symptoms worsen or new ones appear with a change in your neurological examination. MS relapses may occur at any time, usually without warning. They may be mild or severe. In relapsing MS, relapses are followed by a long or short period of time when symptoms completely or partially go away.

The intensity and impact of relapses can range from mild to severe. They may even be hard to identify at times. For example, you may feel tingling in your fingers—and while you may think it’s just a part of living with relapsing MS, it might actually be a mild relapse.

In MS, remission is a period of time in which your symptoms may partially or completely subside. These periods of time may be either short or long, and may be characterized by a return to a level of health similar or equal to what you were experiencing prior to your last relapse.

Six tips to help deal with MS symptoms

  1. Keep a detailed record of your MS symptoms and duration
  2. Go to all scheduled doctor appointments
  3. Keep physically active when able
  4. Eat a well-balanced diet
  5. Stay cool (symptoms can worsen in the heat)
  6. Seek out support

For symptom-specific tips, go to the individual symptom section.

Five reasons you may want to call your doctor about your MS symptoms:

  1. If you experience loss of vision or blurry vision
  2. If you have an abrupt change in bowel or bladder function
  3. If you think you have a urinary tract infection
  4. If you have feelings of depression or thoughts of hurting yourself
  5. Any time you are concerned about a symptom or feeling

This is a partial list. Make sure to ask your doctor about when you should call.

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Vision problems

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If you’ve ever had double or blurred vision, eye pain, or any visual limitations, you’re not alone. Up to 90% of people living with relapsing multiple sclerosis (MS) have experienced vision difficulties. In fact, a vision problem is often one of the first symptoms of relapsing MS. Fortunately, vision problems are usually temporary.

How can MS affect my eyes?

MS is a disease of the central nervous system (CNS), which includes the optic nerve—the nerve that transmits light and visual images to the brain.

CORNEA OPTIC NERVE

Three visual disorders associated with MS are:

  1. Optic Neuritis
    An inflammation of the optic nerve that can cause a sudden loss of vision, usually in one eye; blurred vision; and eye pain. Optic neuritis is the most common MS-related vision problem. Approximately half of people with MS will have at least one episode of optic neuritis. Frequently, it is the first symptom of MS. Optic neuritis may result in blurring or graying of vision, or, rarely, blindness in one eye. A dark spot may also occur in the center of the visual field.
  2. Nystagmus
    Uncontrolled horizontal or vertical eye movements is another common symptom that impacts vision. Nystagmus may be mild, only occurring when the person looks to the side. Sometimes it may be severe enough to impair vision.
  3. Diplopia
    Occurs when the pair of muscles that control a particular eye movement are weak. The muscles then become uncoordinated. When the images are not properly fused, the person sees a double image. Double vision may increase with fatigue or overuse of the eyes.

A vision problem is frequently one of the first symptoms of relapsing MS. Fortunately, vision problems are often temporary.

Staying focused: MS and the eye

If you are experiencing vision-related symptoms,
there are some things you should know.

Another cause of vision impairment could be a rise in body temperature, whether from strenuous exercise, a hot bath, or the weather. Heat-related vision difficulties usually diminish after you cool off.

Tips for dealing with vision problems caused by MS

Fortunately, vision problems are often temporary and heal on their own. Steroids are sometimes prescribed for optic neuritis and nystagmus. Resting your eyes periodically throughout the day and/or wearing an eye patch can help reduce double vision. If you have any questions or concerns about your vision, contact your doctor.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Bowel/Bladder

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Some multiple sclerosis (MS) lesions can block or delay nerve messages that control the bladder and bowel.

MS symptoms in the bowel/bladder can include these six issues:

  1. Increased frequency in urination
  2. Urgency to urinate
  3. Hesitancy in starting urination
  4. Frequent nighttime urination (nocturia)
  5. Leaking or incontinence
  6. Constipation

The most common problem is called “spastic” bladder. This happens when the bladder is unable to hold the normal amount of urine, or does not empty properly. This can leave urine in the bladder and possibly lead to infection.

If you develop bladder or bowel issues, getting examined and treated early may help you avoid complications.

Constipation is another concern for people with MS. Constipation may be caused by too little fluid intake, by your intestinal tract slowing down, by decreased activity, and/or by certain medications used to control bladder symptoms.

Ten tips for dealing with bowel/bladder issues due to MS:

  1. Change your fluid intake. For example, limit fluid intake a few hours before bedtime, or cut out caffeine
  2. Get examined and treated early if you develop bladder or bowel issues, so that you can avoid any complications, like bladder infections.
  3. Drink at least 6 to 8 glasses of fluid (preferably water) daily, but limit your fluid intake a few hours before bedtime to avoid frequent urination during the night.
  4. Avoid bladder irritants such as alcohol, caffeine, and artificial sweeteners.
  5. Include plenty of fiber in your diet. Fresh fruits and vegetables, whole grain breads, and cereals all contain fiber.
  6. Add exercise to your routine.
  7. Use medicines, such as stool softeners, as recommended by your healthcare provider.
  8. Establish a regular time and schedule for emptying the bowels.
  9. Wait no more than 2–3 days between bowel movements.
  10. Enemas, suppositories, and laxatives may be used to help a bowel movement—talk with your healthcare provider before using any of these options.

Your doctor can help you establish an effective bladder/bowel management program. Occasionally, it may be necessary to consult a gastroenterologist. He or she is a healthcare provider who specializes in treating the stomach and bowel.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Fatigue (feelings of tiredness)

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Fatigue is one of the most common multiple sclerosis symptoms, occurring in nearly 80% of people with MS. Fatigue can feel like lack of physical or mental energy. Even though fatigue is common, it may not be caused by MS.

Five other factors that may cause fatigue:

  1. Weather
    Fatigue can worsen with an increase in heat and humidity.
  2. Other medical conditions
    Even something as simple as a minor infection can sap energy.
  3. Medications
    Some medications (like antihistamines) can cause fatigue as a side effect. Make sure your doctor has the most up-to-date list of all medications you are taking.
  4. Sleep problems
    Problems falling asleep, staying asleep, or getting the right kind of sleep prevent people from feeling refreshed when they wake up.
  5. Depression and anxiety
    These are common in MS and may contribute to fatigue. If you or others close to you notice changes in your mood, or loss of interest in once-favorite activities, be sure to tell your healthcare provider.
Multiple sclerosis and fatigue

Dr Barry Singer shares ways to recognize early signs of fatigue and how to help deal with this symptom.

Dealing with fatigue:

There are a number of options you can discuss with your doctor that may help reduce fatigue as a symptom of MS. Here are six.

  1. Conserve energy
    Rest whenever you can. This will help leave strength for the things you really want to do. Plan and pace your activities. Set priorities. Learn to let go of any guilt that may be associated with not finishing tasks. And don't be afraid to ask family and friends for some help.
  2. Occupational therapy
    This kind of therapy can help simplify tasks at work and home.
  3. Physical therapy
    This can help improve movement and function. It can teach you energy-saving ways of walking (with or without assistive devices) and performing other daily tasks that may have become more difficult lately.
  4. Sleep regulation
    This may involve treating other MS symptoms that interfere with sleep (eg, spasticity, urinary problems) and using sleep medications on a short-term basis.
  5. Psychological interventions
    Stress management, relaxation training, joining a support group, or psychotherapy can teach you ways to deal with your emotions effectively.
  6. Medications
    Talk to your doctor about specific treatments that may help relieve fatigue.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Walking/Balance

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Walking (also known as gait) problems are fairly common for people with relapsing multiple sclerosis (MS).

Five MS symptoms that can affect walking are:

  1. Muscle weakness
    Can cause toe drag, foot drop, and other gait abnormalities.
  2. Spasticity
    Can interfere with walking, since it most commonly affects the leg muscles.
  3. Loss of balance
    Can cause swaying and a ‘drunken’ type of gait known as sensory ataxia.
  4. Numbness
    Can occur in the feet. Numbness can make a person with MS unable to feel the floor, or know where his or her feet are. This is called ‘sensory ataxia.’
  5. Fatigue
    May cause problems with walking when it increases.

Dealing with walking/balance issues:

When it comes to managing walking/balance issues related to MS, exercise, physical therapy, walking aids, and, in some cases, a review of your medications can help. However, MS is different for everyone. So each person’s walking issue needs to be examined on an individual basis.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Cognitive issues

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These issues include difficulty with memory, concentration, and problem solving. Memory loss is the most common mental change in people with multiple sclerosis (MS). It can occur at any time in the course of your MS. Even if you do not have physical signs of the disease, you may experience memory loss.

Examples of memory loss include:

  • Forgetting names, telephone numbers, and recent conversations
  • Difficulty remembering what you just learned
  • Not knowing why you entered a room
  • Losing or misplacing things

Other factors such as heat, stress, depression, and fatigue can all contribute to memory problems.

How does MS impact my memory?

Evidence suggests that memory problems associated with relapsing MS occur when there are many lesions in multiple areas of the brain that result in a breakdown in transmission of nerve impulses responsible for the ability to remember. There are two types of memory loss problems:

Recent memory:

Newly learned information such as names of people you just met. It also includes things you are trying to remember for the future, like a telephone number or taking your medication. Recent memory is most often affected by MS.

Remote and procedural memory:

Information or a skill you learned a long time ago (eg, tying your shoelaces). This type of memory is not as likely to be affected by MS. Other factors such as heat, stress, depression, and fatigue can all contribute to memory problems.

Seven tips for dealing with memory loss due to MS:

  1. Assign a specific spot for items you lose frequently (like keys), and always put them back there.
  2. Use checklists, organizers, and journals so you remember what you need to do.
  3. Repeat and write down important information.
  4. Prioritize and focus on only the most important things of the day.
  5. Try to keep a set schedule.
  6. Do things when you think of them because you may forget later.
  7. Try memory games or puzzles to help ‘train your brain.’

You may want to be tested if you think you are experiencing memory loss. Talk with your doctor about your symptoms and possible treatment options.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Sexual issues

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Sexual issues are often experienced by people with multiple sclerosis (MS). That’s because sexual arousal begins in the central nervous system (CNS), where MS strikes. If MS damages the nerve pathways to the sexual organs, sexual response, including arousal and orgasm, can be directly affected. Sexual problems may also stem from MS symptoms such as fatigue or spasticity. Psychological factors like mood changes may also play a role in sexual function.

Sexuality is a part of life. If you are having sexual problems, please do not ignore them. Speak with your healthcare provider. It may feel like a difficult and embarrassing conversation to have, but remember your healthcare provider is here to help.

The key to a healthy sex life in any relationship is communication.

In women, symptoms include:

  • Reduced sensation in the vaginal/clitoral area or painfully heightened sensation
  • Vaginal dryness
  • Trouble achieving orgasm
  • Loss of desire or response

In men, symptoms include:

  • Changes in arousal and response
  • Difficulty achieving or maintaining an erection (the most common problem)
  • Reduced sensation in the penis
  • Difficulty achieving orgasm or ejaculation
  • Loss of desire or response

Dealing with sexual problems due to MS

While sexual issues can be one of many symptoms of MS, it's worth noting that sexual issues are also common in the general population. If you are experiencing sexual issues, talk to your doctor. He or she can provide a medical assessment to determine whether the issues you are experiencing are a symptom of MS or have another underlying cause. Understanding the cause will help your doctor recommend a plan for treatment.

A variety of therapies treat sexual dysfunction. Men should speak with their doctors about the many options available. Women can relieve vaginal dryness by using over-the-counter personal lubricants. However, petroleum jelly should not be used because it is not water soluble and may cause infection.

Working together to find other ways to give and receive pleasure allows many couples to have satisfying sexual relationships. Abnormal sensations and spasms can often be controlled through the use of medication. If bladder problems exist, techniques such as reducing fluids two hours before intercourse and emptying the bladder prior to sexual activity are helpful.

The key to a healthy sex life in any relationship is communication. Talk with your partner, as well as your doctor. By exploring options and requesting information, you can maintain a satisfying sex life.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Pain

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More than half of people with multiple sclerosis (MS) find that pain is a problem. Pain appears to result from "short circuits" in the pathways that carry sensory impulses between the brain and spinal cord. It is not a predictor of the course of MS. Pain can be broken into two categories: acute and chronic.

In general, acute pain is sudden and chronic pain lasts longer than three to six months. It may last just for a moment or go on for weeks or months. Chronic pain is persistent, and the pain signals in the body can remain active for much longer.

Some types of acute and chronic pain related to MS are:

Acute pain

  • Trigeminal neuralgia is a stabbing pain in the face. It can occur as an initial symptom of MS. It can be confused with dental pain. However, this pain is due to nerves, not cavities.
  • Lhermitte’s sign is a brief, stabbing, electric shock–like sensation that runs from the back of the head down the arms or spine. It can be brought on by bending the neck forward. It can be a signal of a lesion in the upper region of the spinal cord.
  • Dysesthesia is an unpleasant sensation, typically described as burning, which can be evoked or spontaneous.

Chronic pain

  • Burning, aching, prickling or "pins and needles."
  • Pain of spasticity, such as tightness or aching in joints, and muscle spasms or cramps—called flexor spasms—may occur.
  • Back and other musculoskeletal pain, especially lower back pain, can have many causes. They include:
    • - Spasticity
    • - Pressure on the body caused by immobility
    • - Incorrect use of mobility aids
    • - Poor walking posture, unusual walking pattern, and balance problems

Dealing with MS pain symptoms

Pain is a symptom of MS, but you do not have to simply accept it. You should talk to your healthcare provider about pain. An evaluation to pinpoint the source of the pain is essential. Fortunately, there are a number of medications that can help. Speak to your doctor for more information.

Nonmedication treatments may also help and might include exercise, heat, massage, ultrasound, and physical therapy. In addition, biofeedback, meditation, and similar techniques may also be helpful. Again, talk to your doctor about what might be right for you.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Muscle stiffness/Spasms

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What is spasticity? Spasticity means muscle stiffness or spasms. The stiffness may be as minimal as muscle tightness and may not be bothersome at times. Or stiffness may be so severe as to produce painful, uncontrollable spasms. Sudden movements or position changes can bring on spasticity, as can muscle tightness, change in temperature, humidity, infections, or even tight clothing. Spasticity is common in the knee and ankle areas. However, hips, shoulders, and elbows may also be affected.

Left untreated, spasticity can lead to complications like “frozen” joints (called contractures) and pressure sores. These can also act as spasticity triggers. This means they can set off even more symptoms. So it’s important to let your doctor know if you’re going through this (or any other symptom).

Dealing with spasticity related to MS

Spasticity varies from person to person. It should be treated on an individual basis. Your healthcare provider can recommend ways to relieve your MS symptoms. He or she can also track your progress and may make referrals for occupational and physical therapists. Exercise, daily stretching, and changes in activity are all ways to help relieve spasticity. Medication may also be an option for you.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Weakness

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In relapsing multiple sclerosis (MS), weakness can be a result of a problem with nerve signals. You may also experience weakness from lack of activity. Sometimes you may be less active because of fatigue, stiffness, or a relapse. The longer you are inactive, the weaker your muscles can become.

Questions your doctor might ask:

  • Do you ever feel too weak to do things?
  • Do you feel like you need to put more effort than normal into everyday tasks?
  • Are there specific parts of your body that feel weak, or do you feel weak all over?

Dealing with weakness

With this symptom, the strategies for dealing with it depend on the source of the weakness. Talk to your doctor to determine how and why the problem is occurring and to create the best plan to help deal with it.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

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Depression

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What is depression?

Depression is a serious condition that appears to be common in people living with MS. The term "depression" is used broadly when it comes to people with multiple sclerosis. It is often used to describe a wide range of emotions, from feeling down for a few hours one day, to clinical depression, which may last for months. People with MS, as well as their friends and family, need to know that depression, in whatever form, is common.

How does depression affect people with MS?

People living with MS can experience a wide range of emotions including anxiety, fear, anger, frustration, worry, grief, guilt, and stress. Feeling emotional is normal when faced with a chronic illness, and there is no right or wrong way to deal with these feelings. However, it’s important to understand the difference between feeling down and clinical depression.

Depression can be managed

While we still do not fully understand the nature of depression in MS, we do know that:

  1. Stress is a major factor in depression. The stress of dealing with a diagnosis of a chronic disease and the possibility of disability can bring on depression.
  2. The disease process of MS may cause depression. If MS damages areas of the brain that are involved in emotional expression and control, a variety of behavioral changes can result, including depression.
  3. Depression may also be associated with MS-related changes that occur in the immune or neuroendocrine system.
  4. Depression can also be a side effect of some medications, including those used to treat MS.

How do I know if I’m having a major depressive episode?

People with MS often go through a period of grieving. They may grieve the losses they experience due to MS, such as walking or working. This mourning may look like depression. However, grief eventually goes away on its own.

Clinical depression is a serious condition that can last from at least two weeks to several months.

Symptoms of depression appear to be more common in people living with MS. Symptoms of depression may also be associated with some MS treatments. If you experience symptoms of depression or have thoughts of death or suicide, contact your doctor immediately.

Symptoms of a major depressive episode:

  1. Sadness
  2. Loss of interest or pleasure in everyday activities
  3. Loss of or increase in appetite
  4. Insomnia or sleeping too much
  5. Agitation or slowing in behavior
  6. Fatigue (feeling of tiredness)
  7. Feelings of worthlessness or guilt
  8. Problems with thinking or concentration
  9. Ongoing thoughts of death or suicide

Dealing with depression

Depression does not mean that you are "weak." You should not feel ashamed about being depressed or feel the need to hide it. Depression is manageable.

Depression can only be diagnosed by a doctor. Therapy or medication may be needed. A doctor can treat the condition and prevent an even deeper depression that is harder to treat. It may be necessary to try different medications and different doses before an effective medication, or combination of medications, is found. If you suspect you are suffering from depression, please talk with your doctor. He or she can get you the help you need.

Talk now

Talk to one of our MS-certified nurses about this symptom, or any other, at 1-877-447-3243. We’re here to help.

Ideas for dealing with the ups and downs that come with living with MS:

  1. Talk openly about your feelings, so those close to you can learn how best to support you.
  2. Allow for two-way communication. Regular family meetings are good outlets for communication.
  3. Reach out to a loved one if you need help.
  4. Spend time with others.
  5. Get connected to others with MS.
  6. Get involved in the community.
  7. Find time to relax.
  8. Use exercise as an outlet. (Always talk to a healthcare provider before beginning any exercise program.)
  9. Watch out for comfort eating, which may provide a short-term lift, but can provide empty calories that don't offer the nutritional value your body needs.
  10. Laugh as much as possible.
  11. Try to focus on the positive.

Talk to your doctor about what strategies may help you deal with your emotions.

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MS LifeLines Ambassadors are sponsored by EMD Serono, Inc. and Pfizer Inc.

Indication

Rebif® (interferon beta-1a) is used to treat relapsing forms of MS to decrease the frequency of relapses and delay the occurrence of some of the physical disability that is common in people with MS.

Important Safety Information

Before beginning treatment, you should discuss the potential benefits and risks associated with Rebif with your healthcare provider.

Rebif can cause serious side effects. Tell your healthcare provider right away if you have any of the symptoms listed below while taking Rebif.

  • Behavioral health problems, including depression and suicidal thoughts. You may have mood problems including depression (feeling hopeless or feeling bad about yourself), and thoughts of hurting yourself or suicide
  • Liver problems or worsening of liver problems, including liver failure. Symptoms may include nausea, loss of appetite, tiredness, dark colored urine and pale stools, yellowing of your skin or the white part of your eye, bleeding more easily than normal, confusion, and sleepiness. During your treatment with Rebif you will need to see your healthcare provider regularly and have regular blood tests to check for side effects
  • Serious allergic and skin reactions. Symptoms may include itching, swelling of your face, eyes, lips, tongue or throat, trouble breathing, anxiousness, feeling faint, skin rash, hives, sores in your mouth, or skin blisters and peels
  • Injection site problems. Symptoms at the injection site may include redness, pain, swelling, color changes (blue or black), and drainage of fluid
  • Blood problems. Rebif can affect your bone marrow and cause low red and white blood cell and platelet counts. In some people, these blood cell counts may fall to dangerously low levels. If your blood cell counts become very low, you can get infections and problems with bleeding and bruising. Your healthcare provider may ask you to have regular blood tests to check for blood problems
  • Seizures. Some people have had seizures while taking Rebif

Rebif will not cure your MS but may decrease the number of flare-ups of the disease and slow the occurrence of some of the physical disability that is common in people with MS.

Do not take Rebif if you are allergic to interferon beta, human albumin, or any of the ingredients in Rebif.

Before you take Rebif, tell your healthcare provider if you have or have had any of the following conditions:

  • mental illness, including depression and suicidal behavior
  • liver problems, bleeding problems or blood clots, low blood cell counts, seizures (epilepsy), or thyroid problems
  • you drink alcohol
  • you are pregnant or plan to become pregnant. It is not known if Rebif will harm your unborn baby. Tell your healthcare provider if you become pregnant during your treatment with Rebif
  • you are breastfeeding or plan to breastfeed. It is not known if Rebif passes into your breast milk. You and your healthcare provider should decide if you will use Rebif or breastfeed. You should not do both

Tell your healthcare provider about all medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.

The most common side effects of Rebif include:

  • flu-like symptoms. You may have flu-like symptoms when you first start taking Rebif. You may be able to manage these flu-like symptoms by taking over-the-counter pain and fever reducers. For many people, these symptoms lessen or go away over time. Symptoms may include muscle aches, fever, tiredness, and chills
  • stomach pain
  • change in liver blood tests

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Rebif. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Refer to the Instructions for Use that comes with the Rebif® Rebidose® (interferon beta-1a) autoinjector.

This information is not intended to replace discussions with your doctor. For additional information about Rebif, please consult the Prescribing Information and Medication Guide and talk to your doctor. You can also visit rebif.com or call, toll-free, 1-877-447-3243. Rebif is available by prescription only.

Rebif, Rebif Rebidose, Rebiject II, MS LifeLines, and the Rebif logo are registered trademarks of EMD Serono, Inc. or its affiliates.

Brought to you by EMD Serono, Inc. and Pfizer Inc, the co-marketers of Rebif in the US.

This information is intended only for residents of the United States.