Sensory Symptoms in MS

Sensory symptoms are among the most common symptoms of multiple sclerosis. They are often some of the first signs and symptoms of MS and, while invisible to the naked eye, can be among the most bothersome. The list is long and may involve every inch of the human body. While ever-present, these symptoms usually do not predict a poor prognosis. Nonetheless, they are important to understand and manage as best as possible. 

MS Visual Problems

Blurred Vision

For many, the first sign of MS is a blurring of vision indicative of an inflammation of the optic nerve, called optic neuritis, or, if behind the nerve, retrobulbar neuritis. That nerve in the eye is highly susceptible to the effects of MS and bursting with myelin, thus becoming a common target of the immune system active with MS. When inflamed, vision blurs, colors become bleached, and pain in the eye often accompanies the visual difficulties. This often is diagnosed simply by looking in the eye with an instrument (ophthalmoscope) and noticing if the pupil becomes less sensitive to light shined into it. If left alone, the majority will improve over time, but with steroid treatment, vision and pain improve much faster. When healed, there often remain patches of decreased vision, which the brain can accommodate. Blindness is rarely a complication. 

Double Vision

Sometimes, the muscles of the eye are weakened by demyelination in the brainstem. The result is double vision. This obviously makes reading, driving, or even walking difficult, if not impossible. This frightening symptom often improves over time as the brain develops compensation. It often also clears when the inflammation subsides. Patching an eye allows for single vision for tasks but slows the compensation that the brain can develop if allowed. Sometimes special glasses (prism glasses) can help merge the images into one. Neurologists can occasionally see the eyes moving in abnormal directions and may diagnose an internuclear ophthalmoplegia which is indicative of MS at an early stage. This fairly specific MS finding has the eyes going in opposite directions but, surprisingly, is not usually disabling to the individual.

Other visual problems in MS include difficulty maintaining focus on a moving target or rhythmical oscillation of the eyes. To address persistent visual issues, your neurologist may refer you to a neuroptometrist, neuropthamologist or even an occupational therapist with a specialty certification in Low Vision. The occupational therapist can trial low or high-tech equipment to help you compensate for your visual deficits. 

Numbness, Tingling and MS Hug

Numbness, tingling, itching, crawly sensations, and burning pain in the arms and legs are variations of a theme of disturbed electrical conduction in demyelinated nerves within the brain and spinal cord. Like so many MS sensory symptoms, these usually do not present a bad long-term prognosis but can be very disturbing.

A lot has been said about a band-like sensation around the chest, “the MS Hug”. Some have said that it may be a sign of a bad prognosis, but that is not the experience of others. Usually this is due to demyelination in the spinal cord and, like so many sensory symptoms, clears with time.

Little can be done for these MS sensory symptoms, but to develop a conscious awareness and acceptance of their presence and practice compensatory techniques. Occupational or physical therapists are helpful in teaching those techniques. Pain may be treated with medications developed for neuropathic pain and seizures. Biofeedback and meditation techniques can be helpful as well. Sometimes topical creams are useful. 

Dizziness and Vertigo

Dizziness or lightheadedness is very common in MS and may be the initial symptom of the disease. Unfortunately for the clinician, dizziness is not very specific and is commonly seen with a variety of dysfunctions involving eyes, ears, brain, metabolism, heart and other organs. Specific treatment should be aimed at the exact cause, but if that is not found, there are exercises (provided by a physical therapist) and medications available.

Vertigo is a spinning sensation and is often associated with dizziness. Treatment may be similar, but often, it is easier to pin down the cause of the vertigo and treat that specifically. Again, these sensory symptoms are common to many disorders, so a diagnostic workup may be necessary if the cause is not obvious. 

Balance and Coordination Challenges in MS

Balance and coordination are motor abnormalities that involve the sensory system significantly. To keep one’s balance effectively requires input from the eyes, the vestibular (balance) part of ears, sensation in the legs (position sense in the feet), and muscle strength. Disturbance along any of these pathways will have an effect on balance and result in impaired walking with fall potential.

Physical and occupational therapy are essential to the treatment of these issues. There is a whole specialization to therapy of the balance system, vestibular rehabilitation. At times, a physical therapist may need to guide you to use mobility devices like a cane or walker to compensate for these balance issues or even instruct you in other compensatory techniques. 

Explore our Building Your Balance and Walking Challenges exercise series for guided exercise routines to help reduce the impact of these symptoms on your life.

MS Pain

Severe stabbing pain in the face can occasionally be associated with MS. This severe pain is called trigeminal neuralgia and sometimes occurs in the elderly without MS. When it occurs in people below 50, one should look for demyelination. It is treated with neuropathic pain medications and occasionally may require a surgical intervention, of which there are many. 

L’hermitte’s Sign

Some will feel a lightning-like sensation down the spine when the head is bent forward. This is called a L’Hermitte’s sign and occurs because of demyelination in the spinal cord in the neck. Neuropathic pain medications may alleviate this symptom, but it routinely clears on its own. It can be a frightening sensation if not understood. 

Dyspareunia

Dyspareunia is the term given to painful intercourse. This is not common in MS but when present deserves a work-up including gynecological evaluation and potential sexual therapist evaluation and treatment. 

Dysuria

Dysuria means painful urination and is common in MS associated with bladder infections and requires medical intervention with antibiotics, vitamin C, or other management strategies.

Other MS Sensory Symptoms

Cold feet may be the result of a disrupted nerve pathway of the part of the nervous system that controls blood flow to the skin and/or changes in sensation due to the MS. Management may involve warming the feet or the use of niacin as a blood vessel dilator. 

Surprisingly, hearing is not a common problem caused by MS, but it occasionally occurs. Hearing goes from one ear to both sides of the brain (vision does not operate in that manner), so hearing problems are usually transient unless caused by other causes like aging. 

As you can see, there are many sensory symptoms that may happen in MS. It is very important to note that every person with MS is different and will not be experiencing these, even if they are common. It is also important to understand that most of the time, these are more of a nuisance than disabling. However, if one is bothered by any of them there are management approaches for each of them.