What are the types of MS?
The course of MS is unpredictable. Some people are minimally affected by the disease while others have rapid progress to total disability, with most people fitting between these two extremes. Although every individual will experience a different combination of MS symptoms there are a number of distinct patterns relating to the course of the disease:
Benign MS: After one or two attacks with complete recovery, this form of MS does not worsen with time and there is no permanent disability. Benign MS can only be identified when there is minimal disability 10-15 years after onset, that initially would have been categorized as Relapsing/Remitting MS. Benign MS tends to be associated with less severe symptoms at onset (e.g. sensory ). Frequency - approx 20%
Relapsing/Remitting MS: In this form of MS there are unpredictable attacks (exacerbations, relapses), during which new symptoms appear and/or existing symptoms become more severe. This can last for varying periods (days or months) and there is partial or total remission (recovery). The disease may be clinically inactive (silent) for months or years. Frequency - approx 25%
Secondary/Progressive MS: For most individuals who initially have Relapsing/Remitting MS (clear-cut attacks & remissions), over time the disease pattern changes. Recovery from attacks become less and less complete, slowly deficits increase and the disability begins to grow larger as more nerve tissue is destroyed. Attacks become less pronounced and remissions tend to disappear altogether. Frequency - approx 40%
Primary/Progressive MS: This form of MS is characterized by a lack of distinct attacks, but with slow onset and steadily worsening symptoms. There is an accumulation of deficits and disability which may level off at some point or continue over months and years. Frequency - approx 15%

Symptoms of MS
Multiple Sclerosis is a very variable condition and the symptoms depend on which areas of the central nervous system have been demyelinated. There is no set pattern to MS and every MSer has a different, unique set of symptoms, which vary from time to time and change in severity and duration over time.
Visual Disturbances: blurring of vision, double vision (Diplopia) Optic Neuritis, involuntary rapid eye movement, and (rarely) total loss of sight.
Balance & co-ordination problems: loss of balance, tremor, unstable walking (ataxia), foot-drop, giddiness, (vertigo) clumsiness of a limb, and lack of co-ordination.
Weakness: this usually affects the legs and walking.
Spasticity: altered muscle tone can produce spasticity or muscle stiffness which can affect mobility and also can include muscle spasms.
Altered Sensation: tingling, numbness (paraesthesia), or burning feeling in an area of the body, and other indefinable sensations.
Pain: may be associated with MS, e.g. facial pain, (such as Trigeminal Neuralgia), headache, and muscle pains.
Abnormal Speech: slowing of speech, slurring of words, scanning speech, changes in rhythm of speech, and difficulty in swallowing (Dysphagia).
Fatigue: a debilitating kind of general fatigue which is unpredictable or out of proportion to the activity. Fatigue is one of the most common (and one of the most troubling) symptoms of MS.
Bladder & bowel problems: bladder problems include the need to frequently and/or urgently pass water, incomplete emptying, or emptying at inappropriate times. Bowel problems include constipation, a slower digestive system, and infrequently, loss of bowel control.
Sexuality & Intimacy: impotence, diminished arousal, decreased lubrication secretions, and some loss of sensation.
Sensitivity To Heat: this symptom very commonly causes a transient worsening of symptoms. Without its myelin coating, all neural tissue is much more sensitive to heat and prone to stop transmitting, when the body's core temperature is increased by just 0.5F. degrees. However, function will return to "normal" when the body cools off and the nerve can resume transmitting signals.
Cognitive & Emotional Disturbances: problems with short term memory, concentration, judgement and/or reasoning skills are slowed, but rarely are they totally lost.
While some of these symptoms are immediately obvious, others such as fatigue, altered sensation, memory and concentration problems are often hidden symptoms (Invisible Symptoms). These can be difficult to describe to others and sometimes family and doctors do not appreciate the effects these have on MSers and on employment, social acitvities and quality of life.

Diagnosing MS
Early MS may present itself as a history of vague symptoms which may have subsided and many of the Signs could be attributed to a number of medical conditions. Therefore, a period of time may elapse and a prolonged diagnostic process may be involved before MS is suggested or confirmed. On the other hand, a possible diagnosis of MS may be more clearcut with classic symptoms (e.g. Optic Neuritis) and a distinct chronology of attacks. The Neurologist requires evidence that the types of neurological deficits indicate involvement of at least TWO different areas of the central nervous system with effects occurring at TWO separate and distinct time periods.Multiple Sclerosis is essentially a clinical diagnosis and there are NO tests which are specific for the condition, and NO single test is 100% conclusive. Therefore several tests and procedures are needed to establish a diagnosis of MS, they include the following:
Medical History The physician will ask for a medical history, which will include your past record of signs and symptoms, as well as the current status of your health. The type of symptoms, their onset and pattern may suggest MS; but a full neurological examination and medical tests will still be needed to confirm the diagnosis.
Neurological Examination The Neurologist will test for abnormalities in nerve pathways. Some of the more common Neurological Signs involve changes in eye movements, limb co-ordination, weakness, balance, sensation, speech, and reflexes. However, this examination cannot conclude what is causing the abnormality, and so other possible causes of illness which produce similar symptoms to MS must first be eliminated.
Visual & Auditory Evoked Potentials When Demyelination (scarring) occurs the conduction of messages along the nerves may be slowed. Evoked Potentials measure the time taken for the Brain to receive and intepret messages (Nerve Conduction Velocity). This is done by placing small electrodes on the head which monitor brain waves in response to Visual and Auditory (Hearing) stimuli.
Normally, the Brain's reaction to such stimuli is almost instantaneous, but if there is demyelination or a lesion in the nerve pathway a delay may occur and the response time will be significantly slower than normal. This test is not invasive or painful and does not require a hospital stay and often will document the presence of a lesion which does not show up on an MRI scan.
Magnetic Resonance Imaging (MRI) The MRI scanner is a more recent diagnostic test and takes very detailed pictures of the Brain and Spinal Cord, showing most existing areas of Sclerosis (Lesions or Plaques). While this is the only test in which the Lesions of Multiple Sclerosis can be seen, it cannot be regarded as conclusive, particularly since not all lesions are picked up by the scanner and because many other conditions can produce identical abnormalities. The MRI clearly shows the size, quantity and distribution of most lesions, and together with supporting evidence from medical history and neurologic examination, can be a very significant indicator toward confirming the diagnosis of MS. The MRI is also a very useful tool in clinical trials in assessing the value of new therapies, by its ability to objectively measure disease activity in the brain and spinal cord.
Lumbar Puncture In this test, Cerebrospinal Fluid (the fluid which flows around the Brain and Spinal Cord) is tested for the presence of antibodies. Antibodies can occur with MS, but they can also occur with other neurological conditions. The fluid is taken from the Spinal Cord by inserting a needle into the back and withdrawing a small amount of fluid. A local anaesthetic is given to numb the skin, and therefore while it is uncomfortable it is not usually painful. This test does require the person to lay flat for a number of hours after the test (some experience very painful headaches when standing or sitting), and may require an overnight stay in a hospital. Subsequently for some, a short period of recuperation may be required. This test may indicate MS but is NOT in itself conclusive. The diagnosis of MS is not always clear cut. The initial symptoms may be transitory and vague and confusing to both the person and the doctor. Invisible and/or subjective symptoms are often difficult to communicate to doctors, who often do not believe what they cannot see ( If I don't see it, you do not have it.) and too often dismiss people as being neurotic or a hypochondriac. Following an episode for which you have sought medical advice, your doctor may not have even told you MS was suspected, because the neurologist may want to see at least two distinct episodes with symptoms that are separated by at least one month and lasting for at least 24 hours ( Poser Criteria). This medical criteria must be met before a confirmed diagnosis of Multiple Sclerosis can be reached. A good relationship with your neurologist and family physician is essential. If you do not have a good relationship with your neurologist, by all means, take the time to locate one you do have confidence in. MS may have times of crisis and acute episodes which require specialized medical knowledge, but it is a disease that must be lived and managed every day. This goal can only be accomplished, if you and your physican trust and have confidence in each other. The time of diagnosis is stressful not only for MSers, but for the whole family and carers who should also be fully informed of the diagnosis, prognosis, treatment, management, and lifestyle adjustments necessitated by MS. Your family physician and the local MS Society are important ongoing resources for care and information for both you and your family. Receiving the diagnosis of MS can be a shock and often stereotypes of impending wheelchairs and disability tend to dominate one's thoughts. But, try to remember that many of us have learned how to truly live life to the fullest. You must learn to allow for the demands caused by this disease and in time, you will learn how to properly manage your MS and still have a fullfilling life. It may not be necessary for you to stop working, education and social activities, many MSers do have productive and very complete lives.