unusual presentation of ms

9 Surprising Symptoms of Multiple Sclerosis

Many people with MS experience fatigue and mobility issues, but there are other, less common symptoms.

When you have multiple sclerosis (MS), damage to the nerve fibers in the central nervous system (and the myelin coating around them) causes the signals between your brain, spinal cord, and the rest of your body go awry, according to the National Multiple Sclerosis Society (NMSS) . This interference in the transmission of nerve signals is what causes the symptoms of MS .

While symptoms vary greatly from person to person, and can get better or worse over time, more common symptoms include fatigue, walking (gait) difficulties, numbness or tingling, spasticity, weakness, vision problems, dizziness, bladder and bowel problems, sexual problems, pain, cognitive and emotional changes, and depression, per the NMSS .

However, there are also some less common symptoms of MS.

“What’s surprising about MS symptoms is that they can affect so many different functions that people rely on every day in their lives,” says Rosalind Kalb, PhD , vice president of the Professional Resource Center at the NMSS. “Some are physical, some emotional, and some intellectual. We tend to focus on the ones we can all see, but many people may be living with a variety of symptoms that just aren’t apparent.”

Here are some of the less common, more surprising symptoms that you might not be aware of.

Many people with MS experience dizziness, in which you feel light-headed or off-balance, notes the NMSS . A less-common MS symptom is vertigo. When you have vertigo, you feel as though your surroundings are spinning around you, Dr. Kalb says, or that you are spinning. Vertigo in MS is a result of lesions in areas of the brain that coordinate balance. Motion sickness drugs can usually provide temporary relief, but typically do not resolve chronic vertigo from old or prior lesions. Corticosteroids can also be used to treat new or worsening vertigo that is related to a new disease flare-up or lesion.

RELATED: Your Everyday Guide to Living Well With Multiple Sclerosis

2. Speech Disorders

About 25 to 40 percent of people who have MS report having speech problems as a result of lesions or damage in different parts of the brain, according to the NMSS. These symptoms, also known as dysarthria, tend to occur when you’re further along in the course of your disease, and when you’re very fatigued.

Per the NMSS , speech disorders experienced by people who have MS include:

• Scanning speech or scanning dysarthria, where the normal “melody” or speech pattern is altered
• Slurring, which is typically due to weakness or a lack of coordination in the muscles of the tongue, lips, cheeks, and mouth
• Dysphonia or loss of speech volume, which can be due to a weak diaphragm

If you’re having speech problems due to MS, a speech or language pathologist can help, as can assistive devices such as smartphone apps .

What Can People With MS Teach Us?

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3. difficulty swallowing.

You may experience  difficulty swallowing (dysphagia)  if you have MS, particularly in the later stages of the disease, notes the NMSS . This can happen when the nerves that control the muscles in the mouth and throat become damaged. It can also be a result of numbness of the mouth and throat, or mouth dryness due to medication.

Difficulty swallowing can be a serious problem, and it’s important to seek diagnosis and treatment as soon as possible. A speech or language pathologist can teach you strategies and exercises for safer eating and swallowing, and help you make any necessary dietary changes.

RELATED: 11 Lifestyle Tips to Help You Manage MS Symptoms

Some people who have MS experience dysesthesias, or painful sensations in the legs, feet, arms, and hands. They typically feel like burning, prickling, stabbing, ice cold, or electrical sensations, according to the NMSS .

Pruritis (itching) is a form of dysesthesias. When you have MS, the nerves in the central nervous system that convey sensory information can be damaged. This damage can cause you to feel itchy even though you don’t see any irritation. Because the cause is neurological and not physical like a bug bite or rash, topical skin creams won’t help.

Treatment for this type pain or itching may include antiseizure medications and antidepressants, as well as acupuncture, mindfulness, meditation, and cognitive behavioral therapy (CBT).

RELATED:  What You Should Know About MS Complications

5. Hearing Problems

About 6 percent of people who have MS report having impaired hearing, per the NMSS . Rarely, hearing loss can occur as the first symptom of the disease. Hearing loss in MS can be linked to damaged nerve pathways in the brain and the brainstem. However, it’s important to note that hearing loss in MS is very uncommon, and most acute episodes get better over time. Be sure to talk to your healthcare provider to determine what is causing your impaired hearing.

Tremors , or uncontrollable or involuntary shaking, can occur in various body parts as a result of MS-related damage to the nerve pathways that coordinate movements, notes the NMSS .

The most common type of tremor (and most disabling) that occurs in MS is known as an intention tremor. It’s usually most pronounced during physical movement, and gets worse as you try to grasp or reach for something, or move your hand or foot to a specific spot.

Tremor can make it challenging to perform daily activities like eating, drinking, and getting dressed, and can cause some people to feel embarrassed and to avoid social situations.

Your healthcare provider may try different medications to treat tremor, but finding an effective treatment can be difficult. A few small studies have suggested that cannabis may be helpful, but further research is needed. Occupational and physical therapists can also help you find ways to manage tremor, including the use of assistive devices.

RELATED:  Depression, Anxiety, and MS: What’s the Connection?

7. Headache and Migraine

While headache isn’t considered a hallmark symptom of MS, a meta-analysis published in 2020 reviewed 16 studies covering 3,560 patients and found the pooled prevalence of headache was 56 percent. The review also found that the overall prevalence of migraine and tension headache among people with MS was 27 percent and 10 percent, respectively. Previous studies have found that up to half of people with MS who experience headache have either cortical or brainstem lesions, the review reported.

RELATED: How to Get Rid of a Headache or Migraine Attack Fast

8. Breathing Problems

Breathing problems can occur as a result of MS-related damage to the nerves that control the chest muscles, according to the NMSS . This issue can get worse over time, and be especially exhausting for those who already experience MS fatigue.

Breathing exercises can be helpful, but it’s important to see a healthcare provider who specializes in breathing issues to ensure proper diagnosis and treatment.

9. Loss of or Change of Taste and Smell

Research has shown that many people who have MS experience changes in how food tastes and smells. One study, published in 2016 , found that a significant number of people with MS have a decreased ability to sense all four basic areas of taste: sweet, sour, salty, and bitter, and that these taste deficits are linked to MS-related lesions throughout the brain.

It’s not common, but other people with MS have reported hyperosmia, or an abnormally heightened sense of smell or abnormal sensitivity to odors.

RELATED:  8 Things to Try When MS Affects Your Ability to Taste and Smell

Before you assume that MS is the cause of impaired or decreased taste, get your symptoms checked out by your doctor, as new loss of taste and smell can also be a symptom of COVID-19, among other conditions.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

• What Is MS? National Multiple Sclerosis Society .
• MS Signs and Symptoms. National Multiple Sclerosis Society .
• Vertigo and Dizziness. National Multiple Sclerosis Society .
• Speech Problems. National Multiple Sclerosis Society .
• Swallowing Problems. National Multiple Sclerosis Society .
• Pain and Itching. National Multiple Sclerosis Society .
• Hearing Loss. National Multiple Sclerosis Society .
• Tremor. National Multiple Sclerosis Society .
• Wang L, Zhang J, Deng Z, et al. The Epidemiology of Primary Headaches in Patients With Multiple Sclerosis. Brain and Behavior . January 2021.
• Breathing Problems. National Multiple Sclerosis Society .
• Doty RL, Tourbier IA, Pham DL, et al. Taste Dysfunction in Multiple Sclerosis. Journal of Neurology . April 2016.

Connect with others who understand.

• Resources Newly Diagnosed With MS

Unusual Sensations and MS: Causes and When To Worry

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• The effects of multiple sclerosis (MS) are different for everyone. You may feel heat, cold, stinging, trembling, numbness, stiffness, spasms, itchiness, or unusual sensations.
• Some sensations may not be caused directly by MS but, instead, result from MS treatments or other health conditions.
• Strange sensations aren’t always cause for concern, but new or worsening ones may signal the beginning of an MS flare for some people. Always let your doctor know if you notice any change in your symptoms.

Unusual sensations and symptoms of multiple sclerosis can be a part of everyday life with the condition. In a 2020 survey of more than 1,000 people living with MS, more than half reported that their neurological symptoms made it hard to perform day-to-day activities.

Some symptoms of MS, like fatigue, might be expected — but other sensations, like electric shocks or crawling skin, may feel abnormal or downright weird. Even if you’ve experienced MS symptoms for years, you may find yourself worried about what these unusual symptoms might mean.

What Unusual Sensations Accompany MS?

Symptoms of MS can vary from person to person. For instance, in the 2020 survey, more than 45 percent of participants reported that MS symptoms only had a minor impact on their normal activities while the remaining 55 percent said that their symptoms significantly affected their daily activities.

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Health professionals often categorize these common MS symptoms and sensations as:

• Paresthesia — Unusual sensory symptoms, like pins and needles, crawling bugs, or tickling
• Dysesthesia — Unusual and spontaneous pain sensations, like burning, an electric shock, or shooting pain
• Hyperalgesia — An extreme response to pain
• Allodynia — Pain caused by a stimulus that doesn’t ordinarily produce pain

Although people living with MS experience symptoms differently, the following are some of the unusual sensations most often described by members of MyMSTeam.

Sudden Hot or Cold Sensations

Our nerves play an important role in how we experience sensations like pain, pressure, heat , and cold. As the nerves of the central nervous system (CNS) become more damaged during the course of MS, some strange sensory sensations can result.

“I get burning sensations in my feet 24 hours a day,” one MyMSTeam member said. Another mentioned feeling “mild icy-hot sensations and some numbness.”

A third member described an almost “constant heat sensation” in the bottom of their right leg: “It feels like an iron is very close to my leg, or the heat from a magnifying glass and the sun is generating heat on my leg, or a hot iron is really close to my leg.”

Not all temperature-related sensations involve heat — some people describe cold flashes. “Since October I have been experiencing a super-cold sensation on my right side in different spots,” one member shared. “The cold sensation is so bad that it feels like it’s burning.”

Numbness and Tingling

With nerve damage, numbness and tingling are common and may be among the early symptoms of MS . More than 29,000 MyMSTeam members experience numbness. Here’s how some members have described numbness and tingly or prickling sensations:

• “My fingertips and feet feel numb. It’s not any pain, just weird sensations.”
• “I describe mine as a weird kind of tingling sensation in my cheeks.”
• “Numbness and pinpricks in my arms and hands.”
• “I often get tingling/sunburn sensations that elevate to a rashlike itch.”
• “My left shoulder area is getting prickly sensations a lot.”
• “Numbness and burning sensations in my lip, tongue, and gums.”

Extreme Itchiness

Usually, scratching seems to relieve an itch — but for people living with MS, sometimes the itching can be so overwhelming that scratching doesn’t help at all. As one MyMSTeam member described it, “I feel itchy, like there are bugs all over me.”

MS can cause itching in any part of your body, but the upper body seems to be a common location among MyMSTeam members. “I just get randomly itchy all over — mostly my scalp and upper body,” commented one member. “My head is always itchy,” another said. A third member shared that the sensation even interrupts their sleep: “My head and face always itch. I even wake up now because of it.”

Feeling of Crawling Bugs

One of the most unusual sensations that people living with MS describe is the feeling of bugs crawling on their skin. Some MyMSTeam members get this feeling on their face. One described it as a “crazy annoyingly tingly sensation of something light, like a hair or maybe an ant, crawling on your face.”

For others, the sensation affects the torso and limbs. One member described it as “weird sensations going up and down arms and legs — the sensation of things crawling up and down them.” Another said they experience “lumbar pain and weird sensations, like crawling bugs.”

Electric Shock Sensations

Damage to the nervous system can lead to feelings of being electrically shocked. MyMSTeam members have offered the following descriptions of these sensations:

• “Electrical shock sensations all over.”
• “A bit of electrical shock sensations throughout the body.”
• “Electric shock sensations in the head.”
• “I can have strange sensations flash through my eyes. Mostly an electric flash sensation.”

If this sensation specifically occurs when you’re lowering your head, it may be something known as Lhermitte’s sign, a symptom commonly associated with MS. With Lhermitte’s sign, an electric shock sensation spreads from the back of the bent neck to the extremities. One MyMSTeam member described it as “a sort of ‘hot flash’ — it starts on my neck and radiates down my back and arms.” Another said the symptom feels like “electrical storms in my back and going into my arms.”

Tremors Throughout the Body

When a person’s CNS nerves become damaged, they can develop tremors (uncontrollable, involuntary shaking or vibrating sensations). Nearly 10,000 members of MyMSTeam report experiencing tremors. One member with this symptom described feeling as though they’re “vibrating, and feeling electriclike buzzing sensations.”

One member shared their experience living with constant tremors. “I get internal tremors that last every day for a few hours,” they commented. “It feels like my whole body is jittery — like a small electrical flow.”

For other members, tremors may ebb and flow. “I have essential tremors, which get worse as the day goes on,” another shared.

Random Spasms and Twitches

A handful of conditions can cause muscle spasms and twitches, but — because of nerve damage — these sensations commonly affect people living with MS. Members of MyMSTeam have shared their experiences with this symptom:

• “Plenty of eye spasms and leg spasms.”
• “I get spasms around my waist during the day.”
• “I get spasms in my chin.”
• “I constantly have muscle spasms in my left leg.”
• “I get spasms as if I have a baby moving inside.”

A particular type of muscle spasm that affects the chest and torso muscles has earned itself a nickname — the MS hug . One member described the hug as “a tightening sensation throughout my body, even occasionally going down my arms.” “Sometimes, it will even squeeze around my chest and make my breathing real tight,” commented another.

Stiff or Tight Muscles

Spasticity refers to an unusual increase in muscle tone, leading to stiffness or tightness. More than 17,000 members of MyMSTeam have reported experiencing spasticity, with one member describing the symptom as “the sensation of being wrapped in 4-inch-wide adhesive tape.”

“Some days, it’s just stiffness and my leg is hard to bend, and other times my leg will tremble when I first stand up,” one member shared.

Another noted that leg spasticity is one of their worst symptoms.

“Aside from causing head and neck pain, it has restricted breathing and caused speaking issues,” a third said.

Muscle Weakness or Pain

Uncomfortable muscle sensations, such as weakness and pain, are common symptoms of MS — and can worsen the flare-ups associated with relapsing-remitting MS. “It’s one of those days where I feel the storm of MS coming,” shared one member of MyMSTeam.

Other members experience difficulty walking or pain with moving certain parts of the body. “My hands are so stiff it hurts to type. My legs don’t want to work, and I can barely get out of bed,” one shared.

One member said that the sudden, painful sensations feel almost like bee stings: “I get them on my abdomen, back, and sometimes on my legs.”

Others describe weakness that involves their entire body. “My legs were so weak and had weird sensations in them, and it has spread everywhere,” one said.

For people living with MS, muscle weakness from nerve damage can also lead to dysphagia (trouble swallowing). “This dysphagia is driving me crazy. I can eat but keep gagging. My throat feels like I swallowed a razor,” shared one member.

Another member expressed a similar frustration: “After I eat, it’s hard to talk. And some days it’s just hard to talk at all.”

What Causes Unusual Sensations in MS?

Although many of these symptoms can feel unusual or weird, they often develop as a symptom of either MS or a comorbidity (co-occurring condition) or as a side effect of medications taken for MS.

Unusual Sensations Related to MS

MS is an autoimmune condition characterized by dysfunction in the immune system, causing damage to the myelin sheath that surrounds and protects the nerves of the CNS and the nerve fibers. Areas of the CNS that have been damaged by inflammation are known as lesions, and symptoms can vary depending on their location.

For example, lesions in the spinal cord are often linked to sensory or motor changes, such as increased pain sensations or trouble with motor skills. Lesions in the brainstem and cerebellum (areas of the brain) can affect the head, face, and mouth, causing symptoms like dysphagia or vision problems, like blurry or double vision.

Unusual Sensations Related to Other Conditions

Certain health conditions often arise in people living with MS, including some that can affect your prognosis (outlook). Some common comorbidities of MS are:

• High blood pressure
• High cholesterol
• Heart disease caused by narrowed blood vessels
• Mental health conditions, including depression, anxiety, and bipolar disorder
• Chronic lung disease
• Sleep disorders

Some of these conditions can cause unusual sensations similar to those that may occur with MS. For example, the World Health Organization (WHO) reports that high blood pressure may lead to buzzing in the ears or tremors. Migraine is known to also sometimes cause paresthesia, with neurological symptoms such as tingling and numbness.

Unusual Sensations Caused by Medication

MS treatments known as disease-modifying therapies (DMTs) help slow the progression of the disease so that relapses (periods when symptoms return) happen less often and are less severe. However, according to the National Multiple Sclerosis Society, some of these treatment options can also lead to side effects that include unusual sensations, such as:

• Flu-like symptoms, including chills, muscle pain, and weakness
• Lowered red blood cell and platelet counts, which can cause symptoms like dizziness and fatigue
• Numbness and tingling in the hands and feet
• Increased pain in the back, arms, legs, and other parts of the body
• Liver complications, including a rare but serious side effect of liver failure, which can cause symptoms like itching

Managing Unusual Sensations

Although unusual sensations may not be cause for worry, for some people with MS, they could be the first symptoms indicative of a relapse. The Multiple Sclerosis in America 2017 survey reported that tingling, muscle weakness and spasms, and pain are among the most common symptoms of MS relapse.

If you notice any new or worsening symptoms, it’s important to reach out to your doctor or neurologist. They can help determine what might be the cause and prescribe medications to help you manage these symptoms.

Although there’s no cure for MS, you can take steps at home to ease some of the uncomfortable symptoms. MyMSTeam members have offered their tips for managing daily symptoms:

• For relief from burning — “I used a bag I made from cotton material and filled it with rice. It can be frozen or microwaved.”
• For pain relief — “Currently using Biofreeze (the roll-on kind) as well as Salonpas pads and Icy Hot Max cream with lidocaine.”
• For relief from itching — “I use oil, not lotion, as I get out of the shower before I dry — and pat dry, not rub. I don’t use anything with perfumes, either.”
• For stiff muscles — “I’ve learned that after applying my massage gun to those areas, the exact pain is relieved by about 80 percent from its initial starting point.”

Did you recently receive an MS diagnosis? Read Just Diagnosed With MS — Now What? 9 First Steps for some ideas on how to cope and stay organized.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 206,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS? Have you experienced unusual sensations like tingling or itching? Share your experience in the comments below, or start a conversation by posting on your Activities page.

• Effect of Multiple Sclerosis on Daily Activities, Emotional Well-Being, and Relationships — International Journal of MS Care
• Altered Sensations — Multiple Sclerosis Trust
• Lhermitte Sign — StatPearls
• MS Hug — Multiple Sclerosis Trust
• Swallowing Problems — National Multiple Sclerosis Society
• Multiple Sclerosis — Cleveland Clinic Center for Continuing Education
• Comorbidity in Multiple Sclerosis — Frontiers in Neurology
• Hypertension — World Health Organization
• Migraine With Aura — StatPearls
• Disease-Modifying Therapies for MS — National Multiple Sclerosis Society
• Relapse Prevalence, Symptoms, and Health Care Engagement: Patient Insights From the Multiple Sclerosis in America 2017 Survey — Multiple Sclerosis and Related Disorders

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Remembering My First MS Symptom

by Ed Tobias | April 29, 2022

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What was your first MS symptom ?

Mine — the one that made me realize something was really wrong — was my inability to squeeze the toothpaste tube with my left hand one morning. Of course, there were earlier hints of trouble. I was unusually tired while attending a business conference. On the flight home from that conference, I felt spacey — there’s no other way to describe it. Another time, I accidentally drove through a red light because my peripheral vision suddenly narrowed and I failed to see the traffic signal to my right.

My wife made fun of me for complaining my legs were getting tired after only a couple of runs down an easy ski slope. One day she accidentally tapped my left foot and it began to shake. It was clonus , another MS symptom. I didn’t know that, but my wife, a physical therapist, did.

Gray Matter Loss in Spine Crucial, But Difficult, Marker of MS Disability

I saw a doctor, and when she tapped my left knee with a rubber reflex hammer, my leg shot out so fast and far that I kicked her in the stomach. But it was my weak left hand that bothered me the most. I knew, after trying to ignore things, that I wouldn’t be able to squeeze this toothpaste back into the tube. That was in 1979. I was diagnosed in August 1980.

A lot of symptoms on my chart

Since my diagnosis, I’ve lived with a medical chart full of symptoms, as most of us do. The most debilitating has been my left foot drop and my general leg weakness. It’s hard to walk more than about 100 steps, even using two canes and a Bioness L300 Go functional electronic stimulator. Other symptoms include fatigue, heat sensitivity, spasticity, restless legs in bed, and bowel and bladder problems. Oh, of course, there’s also “cog fog.” I almost forgot.

My bladder and bowels have improved over the past few years, as has my fatigue. My vision problem only occurred that one time, and my weak left hand returned to normal after my first infusion of the steroid Solu-Medrol (methylprednisolone sodium succinate).

Your symptoms may vary

I’m revisiting these symptoms because of a project recently started by my friend and former MS News Today columnist Laura Kolaczkowski . Laura has begun producing the podcast “ MS Diagnosis Journey .” It’s a series of short chats with people with MS about how they discovered their illness, the diagnostic tests they took, their experience with neurologists, and the like. It’s all information that’s likely to be especially interesting and useful to MS “newbies.” The podcast can be found on all the major podcast platforms, or you can search “MS Diagnosis Journey podcast” to listen via a website. I expect my interview to be available on May 12.

I also just discovered an A to Z listing of MS symptoms in the latest issue of Momentum , the National MS Society’s magazine and blog. The story includes 23 symptoms, such as fatigue, the “MS hug,” and kissing issues. (The letters X, Y, and Z are rolled into a “ways to live well” lump.) It’s an interesting read.

What were your first MS symptoms and when did you notice them? Please share in the comments below. You’re also invited to visit my personal blog at www.themswire.com .

Note:  Multiple Sclerosis News Today  is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of  Multiple Sclerosis News Today  or its parent company, BioNews, and are intended to spark discussion about issues pertaining to multiple sclerosis.

About the Author

Yvonne Ashman

For years I suffered with overwhelming fatigue which I put down to being lazy, and spells of vertigo that put a stop to my motorcycle riding and made me a pedestrian. Symptoms were so vague, so I kept them to myself for years. I'd always been slapped down by the medical profession as I was obese, and, as far as they were concerned, all I needed to do was exercise more and eat less - et voila! - I'd be miraculously cured of everything from a broken toe to migraine. (Despite spending 4 hours a day speed walking and crunching numbers at the local gym...plus eating less than 800 calories a day. Go figure...)

In 2012 I lost the vision in my left eye...a quick visit to my optometrist, a few eye tests, and I was rushed to the Eye and Ear Hospital in Melbourne. Twelve months of testing later and an MRI showed what the problem had been all along...

I don't beat myself up anymore about 'being lazy'...and, I've lost weight to help with mobility. Strange what the right advice can do for you...It's not all plain sailing with the medical professionals I see, but I now have a focus and an understanding that sometimes I need to adjust my expectations, compromise and develop new ways of achieving my goals.

Thanks for sharing all of that. I've heard so many stories over the years of docs who think all that's needed is more exercise and less food that I could write a book. (Gee, actually I have written a book. It's called "The Multiple Sclerosis Toolbox." Shameless plug.) It sounds as if you've managed to turn things around a bit since your diagnosis by following my favorite advice: Life isn't about hiding from the storm, it's about learning to dance in the rain. Bravo to you!

Karen Bates

My first symptom appeared on the 6th Feb 2012 (quite precise I know, but it was my partners birthday on the 10th Feb and it was the following day (the 11th Feb) when I had my second symptom - waking up very very tired). My original symptom was my hands felt ‘funny’. I couldn’t even wash my hair as my hands didn’t feel ‘right’. I needed help doing this. Despite this, I still went in to office (I was a very conscientious PA and constantly busy), so after I really couldn’t function properly on the 11th Feb, I never made it back in to the office, which I was sad about as I genuinely loved my job. I was 34 when it happened, and had to retire at 36 ☹️.

I'm really sorry that you had to retire so young. It makes me even more appreciative of being able to work, full-time, until I was 64. Have you been able to do something else to keep you involved in things since you retired?

I can’t remember a “first” symptom. I was aware of frequent fatigue, but like Yvonne assumed I was just lacking initiative! Interestingly, it was usually associated with stressful situations, of which there many with my narcissistic mother (RIP) and ex-husband. Wish I had known what was going on at the time. Would have improved my self esteem to know I was not “to blame” for the lack of energy. SIGH….

I have no doubt that stress also played a role for me, working in the broadcast news media for a boss who I didn't get along with, when I was diagnosed. It'll be interesting to read the experiences of others. Thanks for sharing yours.

Deidre Squairs

My first symptom appeared in the fall of 2017, I was a struggling first time mom with a 5 month old trying to balance work, home and myself. I was doing an Alzheimer's walk with my son and husband when it started to feel like I was walking through knee high water. I couldn't even make it one lap around the race area. The leg weakness had been occurring on and off over the past week, but this was the worst. At the time I thought that it was just stress, I had been struggling with breast feeding and decided that it was time to call it quits, I had done my best and that was ok. The leg weakness went away. Turns out I was right, that it was stress, just not stress as I knew it. In December 2020, I had my annual physical with my PCP and I noted having a lot of anxiety, I am a health care worker and COVID was taking over our lives. My PCP didn't seem too concerned because my symptoms weren't alarming. I worked on non medicinal treatments which did help for a time. Labor Day weekend 2021 I started having eye pain, my facility had just started using a full electronic medical record, and I was in front of a computer more then ever. At the same time my family was getting ready for my son, who is special needs, to start Pre-K, which was very stressful. Over the course of the weekend I lost vision in my right eye. After seeing my PCP, an ophthalmologist, going to the ER to be admitted to the hospital, 2.5 hours of MRI and a lumbar puncture I was diagnosed with MS. I was 33 year old.

I feel very lucky that I have not had any long term effects from my symptoms. My legs haven't had any weakness since 2017. My increased anxiety that I experienced has been helped by stress management. I am now rocking a pair of black framed glasses, that I actually love. My husband is very supportive, and continues to remind me that MS is manageable, and manage we will.

Thanks for sharing all of that. I'm sure that many of us can associate with your story. (Well, maybe not the breast feeding for me.) Stress seems to be the common denominator here. It certainly played roll for me, when I was DXed at 32. I'm glad that things are going well for you and I think your overall attitude has something to do with that. Also, THANK YOU for whatever roll you played in working with COVID-19 patients. We're still not out of the woods but I think we know the path we need to follow to get us there.

Nancy Starks

My first symptom was double vision at the onset of my MS (in 2004); which I understand is the lessor of the two vision symptoms that can occur when diagnosed with MS. My first bout of this was when I had the flu and my eyes went back to normal after I recovered from the flu. Two months later it came back with a vengeance and lasted six to eight weeks. It was during this time that I received my MS diagnosis. Eventually my vision came back to normal. The medical term for the double vision I experienced is Internuclear ophthalmoplegia.

I was 57 and the major symptom happened overnight when I woke up with transverse myelitis. I knew right away what it was because I have a daughter who also had TM and was diagnosed with MS when she was almost 20. I had a brain MRI showing brain lesions were inactive so I probably had MS before that time but did not know it. I did have before the TM symptom occasional mild MS hugs but at the time had no idea what they were and my internist did not think much about them either. After my MS diagnosis, I found out what MS hugs were online. Other than that I had no clue anything was wrong. I have not had anyactive lesions since although there was a period of time after diagnosis and after starting Copaxone that I had no MRI's done (-I changed neurologists since.) After age 70, four yrs ago, I stopped with the MS DMT. I am glad that so far I have no major disabilities. My last 3 annual MRIs have been negative and I have another in two days.

Cathy Chester

Numbness, weakness, and fatigue.

I was walking through the Manhattan bus terminal (Port Authority) on my way home from work when one of my high heels came off my foot. I only noticed it when I realized I was walking "crooked" and glanced back 10 feet to see my lovely high heel being kicked around by busy travelers! My feet were so numb I never felt the shoe slip off.

That's when I realized I better call the doctor!

Thanks for sharing that. Growing up in Manhattan I know the Port Authority terminal well and have heard many tales about it, but yours is unique! But you've only told us half...how were you able to hobble home?

It was 1984 I was 28. High stress demanding job (Both conditions I thrived on.) Double vision and an astute and awesome ophthalmologist who suspected MS. An appt with a neurologist and MRI followed. MS (which I had never heard of) was confirmed. No DMTs at the time and neuro basically said "good luck". Stuck w/ the ophthalmologist and dumped the neurologist. Kept working at the same job (which I loved) and disguising my MS for the next 28 years (through some at times elaborate schemes a/k/a cover lies). My MS progressed and physical limitations increased. When I felt I could no longer do my job at the level (I) expected of myself, I "retired" and let out the truth. Two wonderful kids (now adults) and a fulfilling career later I realize I was/am a lucky one. My physical decline was slow. Last 5 years sees me able to walk in the house w/ two canes or a walker, but use an electric scooter for anything else. Would love to do stem cell transplant but age 65 and having had MS now for 38 years is not the target patient profile.

Thanks for sharing that. It looks like we've traveled similar paths. DXed in 1980 at age 32, stressful job, minimal visible symptoms for about 20 years, now two canes and a scooter. And yes, we are lucky.

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• Case report
• Open access
• Published: 27 February 2015

Spinal segmental myoclonus as an unusual presentation of multiple sclerosis

• Raed Abdullah Alroughani 1 , 2 ,
• Samar Farouk Ahmed 3 , 4 ,
• Riyadh Ahmed Khan 3 &
• Jasem Yousef Al-Hashel 3 , 5  

BMC Neurology volume  15 , Article number:  15 ( 2015 ) Cite this article

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Metrics details

Unusual presentations of multiple sclerosis (MS) at onset may post a diagnostic dilemma to the treating neurologists. Spinal myoclonus is rare in MS and may lead to perform extensive investigations to rule out other etiologies affecting the spinal cord.

Case presentation

We described a 31-year-old male who presented with involuntary brief jerky movements of the left shoulder and arm with significant wasting of shoulder muscles. In retrospect, the patient had a progressive right leg weakness one year prior to his presentation. Needle electromyography confirmed the presence of rhythmic irregular burst discharges in motor units of muscles expanding from the third to the sixth cervical region with normal nerve conduction parameters. There was no evidence of cortically generated myoclonic jerks using time-locked electroencephalogram. Magnetic Resonance Imaging of the brain and cervical cord along with the presence of oligoclonal bands in cerebral spinal fluid confirmed the diagnosis of MS. Based on the history and progressive clinical features, a diagnosis of primary progressive MS was established.

Spinal myoclonus can be the presenting manifestation of MS in association with demyelinating plaques in the root exit zones of the spinal cord. Spinal myoclonus may pose a diagnostic challenge when it presented at the disease onset and especially in patients with progressive course at onset. Our patient represents the first reported primary progressive MS case in the literature with spinal myoclonus presentation.

Peer Review reports

Segmental myoclonus refers to involuntary brief rhythmic contraction of group of muscles supplied by one or more contiguous segments either in the brainstem or the spine (spinal segmental myoclonus) [ 1 ]. Spinal myoclonus can be caused by trauma, spondylosis, tumors, infections, myelitis, or ischemia [ 1 , 2 ]. We describe a patient with spinal segmental myoclonus as a rare presentation of multiple sclerosis (MS).

A 31-year-old male soldier presented with a 2-month history of brief involuntary jerking of the left shoulder and arm, which persisted during sleep. In retrospective, he developed subacute weakness of his right lower limb one year ago. He had been using a cane to support his walking. He denied any associated neck pain, limb or facial parasthesia, bulbar or sphincteric symptoms. His past medical and family histories were unremarkable. At presentation, neurological examination revealed myoclonic jerks at left shoulder involving both agonist and antagonist muscles along with wasting of supraspinatus, infraspinatus, subscupularis, triceps, biceps, deltoid, and brachioradialis muscles. Weakness of proximal muscles of left upper limp (grade 4/5 on the Medical Research Council “MRC”) and distal muscles of right lower limb (grade 3/5 on MRC) were noted. There were bilateral leg spasticity and exaggerated deep tendon reflexes and extensor planters. Cerebellar and sensory examination were unremarkable apart from positive Romberg’s. Gait was spastic.

Routine hematological and biochemical laboratory investigations including serum calcium, copper, ceruloplasmin levels, thyroid hormone levels, and sedimentation rates were within normal limits. MRI brain and spine revealed multiple demyelinating lesions in the brain, cervical and thoracic spine satisfying Barkoff criteria [Figure  1 ]. There were intramedullary demyelinating plaques at C3 and C4-5 spinal levels corresponding to the involuntary movements. Cerebrospinal fluid (CSF) revealed normal cell counts, protein and glucose but positive for oligoclonal bands. Secondary causes of myoclonus such as infectious disease (HIV, HSV, syphilis, HTLV 1 & 2) were excluded. Autoimmune profile including ANA, ENA, and serum ACE along with screening tests for leukodystrophies and paraneoplastic disorders were negative. Nerve conduction study (NCS) was within normal limits whereas needle electromyography (EMG) revealed rhythmic irregular burst discharges with a rate of 1–3 Hz in motor units of muscles expanding from the third to the sixth cervical region. Electroencephalogram was normal. Visual-evoked potential (VEP) was delayed in both eyes and somatosensory evoked potentials (SSEP) showed low cervical but well-defined cortical responses after stimulation from the left side.

MRI brain and cervical spine images. A) Axial Fluid-Attenuated Inversion Recovery (FLAIR) image of the brain showing demyelinating plaques in periventricular and juxtacortical regions; B) Sagittal T2 image of the cervical spine showing intramedullary demyelinating plaques at C3 and C4-C5 levels.

The history along with the involvement of multiple neuroaxis on clinical examination and paraclinical tests, were supportive of a demyelinating disorder. The patient was diagnosed as primary progressive multiple sclerosis (PPMS) according to the revised 2010 McDonald diagnostic criteria [ 3 ]. The patient refused treatment with intravenous methylprednisolone and elected to have symptomatic treatment. He showed a good response to oral levetiracetam 500 mg twice daily and oral baclofen 10 mg twice daily in helping myoclonus and spasticity respectively.

We described an unusual presentation of spinal myoclonus in our patient as part of a progressive demyelinating disease (PPMS). The initial presentation was due to partial myelitis resulting in leg weakness one year prior to the onset of myoclonic jerks. MS demyelinating plaques at root exit zones involving contiguous spinal segments can cause spinal segmental myoclonus. In our case, there was no evidence of this being cortical in origin given the absence of time-locked cortical correlates in the back-averaged EEG activity preceding spontaneous jerks, and cortical response in SSEPs were of normal amplitude. Propriospinal myoclonus is an additional form of spinal myoclonus that had been described in the literature in which extensive contraction of axial and trunk muscles through as slowly conducting propriospinal pathways [ 4 , 5 ]. Both spinal segmental and propriospinal terms may be intermixdly used when continuous groups of axial and proximal limb muscles were affected.

The pathophysiology of spinal myoclonus is poorly understood. Proposed mechanisms included the loss of inhibitory function of local dorsal horn interneurons, abnormal hyperactivity of local anterior horn neurons, aberrant local axons re-excitations and loss of inhibition from supra-segmental descending pathways [ 1 , 5 , 6 ]. Demyelinated axons can be abnormally hyper-excitable and can display spontaneous discharges, which alone, or driven reflexibly, could lead to myoclonus [ 7 ]. In our case, the presence of cervical lesions at the root exit zones may result in disinhibition of alpha motor neurons and disruption of spinal interneurons circuits leading to the development of myoclonus.

Only a handful of MS cases were reported in the literature along with other demyelinating disorders as shown in Table  1 . In 1986, Jancovic and Pardo reported a series of 19 patients with segmental myoclonus. Six patients had demyelinating disorder; of whom one had a spinal myoclonus while the rest had brainstem myoclonus [ 1 ]. Another case presented with right arm and upper trunk myoclonus was described in 1992 and found to be due to demyelinating plaques at C3-C4. The authors concluded that the case represented a propriospinal pattern [ 4 ]. Khafizova et al. described a similar case with spinal segmental myoclonus caused by a cervical cord lesion which turned by be MS [ 8 ]. Spinal myoclonus was reported in other demyelinating disorders such as ADEM [ 9 ], NMO [ 10 , 11 ] and idiopathic transverse myelitis [ 12 ]. Nevertheless, our patient is the first PPMS case to be reported in the literature with a presentation of spinal segmental myoclonus.

Segmental spinal myoclonus caused by MS demyelinating plaques could represent a diagnostic challenge at the time of presentation and might lead to exhaustive investigations to exclude other causes of myoclonus.

Written informed consent was obtained from the patient for publication of this Case report and any accompanying images.

Abbreviations

Acute disseminated encephalomyelitis

Cerebral spinal fluid

Electroencephalogram

Electromyography

Medical research council

Magnetic resonance imaging

Multiple sclerosis

Nerve conduction study

Neuromyelitis optica

Somato-sensory evoked potential

Visual evoked potential

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Disclosures

Dr Alroughani received honororia from Biologix, Bayer, Merck Sorono, GSK, Genzyme and Novartis, and served on advisory boards for Biologix, Novartis, Genzyme and Merck Sorono. Drs. Ahmed, Khan and Al-Hashel have nothing to disclose.

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Raed Abdullah Alroughani

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Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait

Samar Farouk Ahmed, Riyadh Ahmed Khan & Jasem Yousef Al-Hashel

Department of Neurology and Psychiatry, Faculty of medicine, Al-Minia University, Minya, Egypt

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RA, SA, RK, JA were involved in the care and treatment of the case. RA and SA drafted the initial manuscript. RA, SA, RK, JA reviewed and approved final manuscript.

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Alroughani, R.A., Ahmed, S.F., Khan, R.A. et al. Spinal segmental myoclonus as an unusual presentation of multiple sclerosis. BMC Neurol 15 , 15 (2015). https://doi.org/10.1186/s12883-015-0271-y

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Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating and neurodegenerative disease of the central nervous system in young adults. This disorder is a heterogeneous, multifactorial, immune-mediated disease that is influenced by both genetic and environmental factors. In most patients, reversible episodes of neurological dysfunction lasting several days or weeks characterize the initial stages of the disease (that is, clinically isolated syndrome and relapsing–remitting MS). Over time, irreversible clinical and cognitive deficits develop. A minority of patients have a progressive disease course from the onset. The pathological hallmark of MS is the formation of demyelinating lesions in the brain and spinal cord, which can be associated with neuro-axonal damage. Focal lesions are thought to be caused by the infiltration of immune cells, including T cells, B cells and myeloid cells, into the central nervous system parenchyma, with associated injury. MS is associated with a substantial burden on society owing to the high cost of the available treatments and poorer employment prospects and job retention for patients and their caregivers.

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Massimo Filippi, Paolo Preziosa & Maria A. Rocca

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Introduction (M.F.); Epidemiology (S.V.); Mechanisms/pathophysiology (P.P. and A.B.-O.); Diagnosis, screening and prevention (P.P. and M.A.R.); Management (F.P.); Quality of life (A.S.); Outlook (all authors); Overview of Primer (M.F.).

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M.F. is Editor-in-Chief of the Journal of Neurology , has received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis and Teva and receives research support from ARiSLA (Fondazione Italiana di Ricerca per la SLA), Biogen Idec, Fondazione Italiana Sclerosi Multipla, the Italian Ministry of Health, Novartis, Roche and Teva. A.B.-O. has participated as a speaker in meetings sponsored by and received consulting fees and/or grant support from Biogen Idec, Celgene/Receptos, GlaxoSmithKline, Medimmune, Merck/EMD Serono, Novartis, Roche/Genentech and Sanofi-Genzyme. F.P. has received unrestricted academic research grants from Biogen, Genzyme and Novartis, and on behalf of Frederik Piehl, his department has received travel support and/or compensation for lectures and/or participation in advisory boards from Biogen, Genzyme, Merck-Serono, Novartis, Roche and Teva, which have been exclusively used for the support of research activities. P.P. has received speakers honoraria from Biogen Idec, Excemed, Merck-Serono and Novartis. A.S. was a board member of Merck-Serono and Novartis and received speaker honoraria from Almirall, Excemed, Genzyme, Merck-Serono and Teva. S.V. has received consulting and lecturing fees, travel grants and research support from Biogen, Celgene, Genentech, Genzyme, MedDay, Merck-Serono, Novartis, Roche, Sanofi-Aventis and Teva. M.A.R. has received speakers honoraria from Biogen Idec, Genzyme, Merck-Serono, Novartis, Roche, Sanofi-Aventis and Teva and receives research support from the Fondazione Italiana Sclerosi Multipla and the Italian Ministry of Health.

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Spinal segmental myoclonus as an unusual presentation of multiple sclerosis

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• 1 Department of Medicine, Division of Neurology, Amiri Hospital, Arabian Gulf Street, Sharq, 13041, Kuwait. [email protected].
• 2 Department of Medicine, Neurology Clinic, Dasman Diabetes Institute, Kuwait, Kuwait. [email protected].
• 3 Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. [email protected].
• 4 Department of Neurology and Psychiatry, Faculty of medicine, Al-Minia University, Minya, Egypt. [email protected].
• 5 Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. [email protected].
• 6 Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. [email protected].
• 7 Department of Medicine, Kuwait University, Kuwait, Kuwait. [email protected].
• PMID: 25879483
• PMCID: PMC4347575
• DOI: 10.1186/s12883-015-0271-y

Background: Unusual presentations of multiple sclerosis (MS) at onset may post a diagnostic dilemma to the treating neurologists. Spinal myoclonus is rare in MS and may lead to perform extensive investigations to rule out other etiologies affecting the spinal cord.

Case presentation: We described a 31-year-old male who presented with involuntary brief jerky movements of the left shoulder and arm with significant wasting of shoulder muscles. In retrospect, the patient had a progressive right leg weakness one year prior to his presentation. Needle electromyography confirmed the presence of rhythmic irregular burst discharges in motor units of muscles expanding from the third to the sixth cervical region with normal nerve conduction parameters. There was no evidence of cortically generated myoclonic jerks using time-locked electroencephalogram. Magnetic Resonance Imaging of the brain and cervical cord along with the presence of oligoclonal bands in cerebral spinal fluid confirmed the diagnosis of MS. Based on the history and progressive clinical features, a diagnosis of primary progressive MS was established.

Conclusion: Spinal myoclonus can be the presenting manifestation of MS in association with demyelinating plaques in the root exit zones of the spinal cord. Spinal myoclonus may pose a diagnostic challenge when it presented at the disease onset and especially in patients with progressive course at onset. Our patient represents the first reported primary progressive MS case in the literature with spinal myoclonus presentation.

Publication types

• Case Reports
• Brain / pathology
• Electroencephalography
• Electromyography
• Magnetic Resonance Imaging
• Multiple Sclerosis, Chronic Progressive / complications
• Multiple Sclerosis, Chronic Progressive / diagnosis*
• Muscle, Skeletal / pathology
• Myoclonus / etiology*
• Spinal Cord / pathology*

BREAKING: A controlled explosion frees the Dali container ship trapped beneath the Francis Scott Key Bridge in Baltimore 

Internet sleuths say Noelia Voigt left hidden message in Miss USA resignation: 'I am silenced'

Eagle-eyed fans of the Miss USA pageant noticed something unusual about 2023 winner Noelia Voigt’s resignation statement about her mental health on Instagram. The first letter of each sentence spelled out “I am silenced.” 

Voigt’s resignation , followed by Miss Teen USA UmaSofia Srivastava’s resignation two days later, sent shock waves throughout the pageant industry and its fan community. The unprecedented nature of the situation, combined with unanswered questions, has created a social media sensation. 

TikTok videos with millions of views, multiple Reddit threads and YouTube deep-dive videos have sought to uncover what Voigt was “silenced” about. Since 2020, former contestants and viewers have used social media to skewer the organization that runs Miss USA, including making favoritism allegations , as the pageant underwent numerous leadership shake-ups.

“We need to listen carefully, because someone is trying to tell us something important,” model and TikTok creator AnnaNoel Olsen said in a video about Voigt’s post that has 2 million views. “I can’t even imagine how many contracts, NDAs, all the things she is under. Her putting this in there was so someone would find out.”

Multiple former members of the Miss USA industry have since spoken out, including former Miss USA and longtime state director Shanna Moakler and former Miss USA social media director Claudia Michelle, who stepped down a few days before Voigt resigned. 

In her post announcing her resignation, Michelle wrote that the role had been her “dream job” but that she had no other team members to help her and that she worked unpaid for the first two months. Michelle wrote that the official Miss USA social media accounts had blocked people and deleted comments without her guidance or approval. 

“This is a women’s empowerment organization and my hope in making this statement is to restore some of the empowerment back to these titleholders that was so deeply lost in their year,” Michelle wrote. “Having not signed any contracts or NDA’s, I feel as if I am in the position to speak on what I have witnessed.”

Michelle wrote that she observed Voigt’s mental health decline and that she saw Srivastava, the Miss Teen USA, and her family being disrespected. She wrote that Voigt and Srivastava were restricted from being able to post about their “personal advocacies” on social media and that management spoke about them in an “unprofessional and inappropriate” way. Michelle also wrote that assistant national directors were “let go” from the organization for undisclosed reasons. 

“I believe their voices and their stories should be heard and not silenced,” Michelle wrote about Voigt and Srivastava.

“I feel the way current management speaks about their titleholders is unprofessional and inappropriate; I disavow workplace toxicity and bullying of any kind,” she said.

Michelle, Voigt and Srivastava did not immediately respond to requests for comment. 

The CEO and president of the Miss USA Organization, Laylah Rose, said in a statement Wednesday that her goal is "to inspire women to always create new dreams, have the courage to explore it all, and continue to preserve integrity along the way."

"I hold myself to these same high standards and I take these allegations seriously," she wrote, without elaborating on which allegations she was referring to. "Please be assured that the well-being of all individuals associated with Miss USA is my top priority.”

Kat Tenbarge is a tech and culture reporter for NBC News Digital. She can be reached at [email protected]

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April 9, 2024

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PowerPoint Forum Top Contributors: Steve Rindsberg  -  John Korchok  -  Bob Jones AKA: CyberTaz   ✅

May 10, 2024

PowerPoint Forum Top Contributors:

Steve Rindsberg  -  John Korchok  -  Bob Jones AKA: CyberTaz   ✅

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Opening PPT file

Hello, my powerpoint file will not open. When I try to open the file, it first says that "Powerpoint found a problem with content in [insert file path name]. Powerpoint can attempt to repair the presentation. If you trust the source of this presentation, click Repair." When I click repair, it then says "Sorry, PowerPoint can't read [insert file path name].

I have already tried all of the methods provided in a previous response to this question posted by another user and none of them worked

" Here are a few things you can try to resolve the issue:

Open PowerPoint in Safe mode:

Try opening the file in PowerPoint Safe Mode. To do this, press and hold the Ctrl key while opening PowerPoint.

This will disable any add-ins or customizations that may be causing the issue.

Open file on different device.

Try opening the file on a different computer or device to see if the issue is specific to your computer.

If you have a backup of the file, try opening the backup copy.

Unblock the file :

Right-click on the file and select  Properties . In the Properties window, select the  General  tab and click on the  Unblock  button. Then click  OK  and try opening the file again.

Add the file location to the trusted locations list :

Open PowerPoint and click on  File  >  Options  >  Trust Center  >  Trust Center Settings  >  Trusted Locations . Click on  Add new location  and browse to the location of your file. Then click  OK  and try opening the file again. "

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Replies (1) 

• Microsoft Agent |

Hello Ortega_389,

Thanks for your post in Microsoft Community.

I understand that the issue you are experiencing with the PowerPoint file is frustrating. Based on your description, the file appears to be corrupted, and there may not be a straightforward solution to recover it. I would also like to confirm two questions with you:

Are you unable to open only a single file or all PowerPoint files?

Is the location of your opened file local or in the cloud ?

If it is a locally saved file that cannot be opened and you have not made any backups, given that none of the methods you have tried have worked, contacting a professional data recovery service may be your best option, and I hope your issue can be resolved.

Best Regards,

Jonathan Z - MSFT | Microsoft Community Support Specialist

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