fatigue (weakness or tiredness)
sensory: paresthesia (numbness or tingling), trigeminal neuralgia (pain or burning in the face)
visual: optic neuritis (blurred vision, dark spot in the center of vision in one eye – scotoma – or visual loss), diplopia (double vision)
motor: muscle weakness, difficulty walking, muscle spasms and stiffness (spasticity)
ataxia: lack of coordination in movements or walking, dizziness, and imbalance
sphincter-related: difficulty controlling the bladder (retention or incontinence) or bowel
cognitive: memory problems, attention deficits, slowed information processing
mental: mood changes, depression, and anxiety

Clinical Forms of MS:

relapsing-remitting MS (RRMS)
secondary progressive MS (SPMS)
primary progressive MS (PPMS)
primary progressive MS (PPMS)

The first form, relapsing-remitting MS (RRMS), accounts for about 85% of cases. It is characterized by episodes of neurological symptoms (relapses) followed by recovery, either spontaneously or with treatment. This form typically appears in the early years of the disease, often with full recovery and no lasting damage. Relapses last for days or weeks and, on average, occur once a year if no proper treatment is started.

Within approximately 10 years, about half of these patients will progress to the secondary progressive form (SPMS). In this stage, patients no longer fully recover from relapses and begin to accumulate permanent damage. For example, they may experience permanent vision loss or increasing difficulty walking, potentially requiring mobility aids such as a cane or wheelchair.

In the remaining 10% of cases, the disease presents as primary progressive MS (PPMS), characterized by a gradual worsening of symptoms, without distinct relapses.

About 5% of patients develop a more aggressive and rapidly progressing form called progressive relapsing MS (PRMS). This form combines continuous disease progression with acute relapses and involves earlier and more severe axonal damage.

Diagnosis

The diagnosis of multiple sclerosis (MS) is based on the 2017 McDonald Criteria, which consider various clinical and imaging aspects, along with cerebrospinal fluid (CSF) analysis for specific markers. Magnetic resonance imaging (MRI) of the brain and spinal cord is the main tool for diagnosing demyelinating diseases of the central nervous system (CNS).