Multiple Sclerosis: Symptoms and First Signs in Women and Men

Multiple sclerosis is a disease in which the immune system attacks myelin, the sheath of nerve fibers in the brain and spinal cord. Signals between the brain and body slow down or become blocked, and the disease manifests with many different symptoms. Let us examine how it begins and how it differs in women and men.

Multiple Sclerosis: What Kind of Disease It Is

Myelin is needed by nerves to conduct signals quickly; damage to the sheath leaves dense scars in the white matter, which gave rise to the name "multiple sclerosis." It is believed that the underlying cause is a failure of immune regulation; genetic and environmental factors increase the risk: prior Epstein-Barr infection, smoking, low vitamin D levels.

The disease was first described in 1868 by the French neurologist Jean-Martin Charcot. Today, there are about 2.8 million cases worldwide according to a 2020 estimate, and about one million in the United States in 2022. The usual age of onset is from 20 to 50 years.

The course is divided into forms. Relapsing-remitting, the most common, alternates exacerbations and recovery. Secondary progressive follows it, when symptoms are constantly present and slowly worsen. Primary progressive is less common and worsens from the very beginning.

First Signs of Multiple Sclerosis

The disease has no specific first signs: pronounced fatigue, visual disturbances, numbness or tingling in various parts of the body, and a feeling of unsteadiness are possible. Symptoms come in attacks and go away, so they are easily attributed to overwork.

Clinically isolated syndrome is distinguished separately — a single episode of typical complaints lasting at least 24 hours; it may turn out to be an early sign of the disease, although it does not progress to multiple sclerosis in everyone. There is also radiologically isolated syndrome: changes are visible on MRI, but there are no complaints.

Main Symptoms: Vision, Sensation, Movement

• Vision: blurriness, double vision, eye pain — often due to optic neuritis.
• Sensation: numbness, tingling, "pins and needles" in various parts of the body.
• Movement: muscle weakness, stiffness, spasms, and cramps.
• Coordination: unsteadiness, dizziness, clumsiness, difficulty walking.
• Other: frequent urination or loss of bladder control, problems with memory and concentration, fatigue, mood changes, sexual disorders.

Symptoms in Women and Men: Are There Differences

The most noticeable gap is in frequency: multiple sclerosis occurs two to three times more often in women than in men. Symptoms depend on which nerves are affected and vary among different people; no separate set of symptoms for women or men has been described.

Among sexual disorders, vaginal dryness and erectile dysfunction are named. Female sex, young age, and infrequent exacerbations at the onset of the disease are statistically considered favorable factors.

Pain in Multiple Sclerosis: Legs, Back, Lower Back

Among pains, eye pain (in optic neuritis) is most often mentioned, as well as spasms, cramps, and muscle stiffness; the doctor assesses the nature of the complaints. Leg pain is not described separately — such a complaint requires a doctor's examination.

Back and lower back pain is not classified as a typical symptom of multiple sclerosis; the cause is determined by a doctor. Independently linking lower back pain to demyelination is incorrect — an examination helps to sort it out.

How the Disease Is Diagnosed and When to See a Neurologist

There is no single test. The doctor takes a history of complaints, checks reflexes, strength, sensation, coordination, vision, and balance, orders a blood test to rule out other diseases, MRI of the brain and spinal cord, examination of cerebrospinal fluid after lumbar puncture, and tests with sensors measuring the speed of signal transmission from the eyes and ears to the brain. The McDonald criteria help formalize the diagnosis.

You should consult a doctor if multiple sclerosis symptoms are suspected: numbness, double vision, weakness, unsteadiness. Such symptoms occur in many conditions, so they need to be checked by a doctor.

Multiple sclerosis itself is not a reason to call an ambulance. Call 103 or 112 if weakness or numbness in one arm, loss or blurring of vision, or disturbances of balance and coordination suddenly appear: such signs may indicate a stroke.

This text is an informational overview, not a diagnosis: only a doctor after an examination can distinguish multiple sclerosis from many similar conditions.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer