Initial signs and symptoms, course and prognosis of multiple sclerosis

1. Big picture

Multiple sclerosis (MS) usually begins in a young adult, often a woman, with a neurological episode that localizes to the central nervous system and then later shows dissemination in space and time.

The key exam idea:

MS often starts with optic neuritis, unusual paresthesia, limb weakness, dizziness, diplopia, ataxia, or fatigue — but the diagnosis must be based on objective CNS signs and follow-up, not on vague symptoms alone.

The most common course is relapsing-remitting MS, which may later become secondary progressive MS. A minority of patients have primary progressive MS from the beginning, usually with progressive spastic paraparesis and w