Headaches

Although headaches were once thought to be an infrequent symptom of MS, more recent studies indicate anywhere from 31% to 57.7% of the test subjects with MS suffered from headaches – the most common being tension-type headaches and migraines.  A study of MS pain (including headaches) found that “in 68% [of the subjects] insufficient care by the physicians consulted was reported.  This was even true for the most frequent pain, migraine, in which clear treatment recommendations exist.  There is thus an urgent need for physicians to keep this problem in mind when treating MS patients.” Another study from the University of California Davis Headache Clinic found evidence that suggests “dysfunction within the midbrain/periaqueductal (1) gray matter caused by a demyelinating plaque …increases the incidence of headache in patients with MS”⁴

Hearing Loss

Hearing loss is considered an uncommon symptom of MS, although existing studies tracking its prevalence vary widely in reported occurrence.  The etiology of Sudden Hearing Loss (SHL) recognizes MS, as well as migraines, as a potential neurological cause.  More often, there is a loss in hearing sensitivity.  MRI tests on brain stem lesions showed that whenever a lesion overlapped the auditory pathway, some BinAural (auditory) performance was abnormal. Other tests show that “up to 40% of MS patients who have normal audiograms experience difficulty hearing in everyday listening conditions” (i.e. background noise).  This can be the difference between hearing sensitivity and processing of auditory information.   Those with cognitive symptoms that include difficulty with information processing find that this can influence the ability to filter and process what is heard.

Hearing loss can also occur during an exacerbation, although deafness due to MS is extremely rare and most acute episodes of hearing loss through MS tend to improve.

Sleep Disorders

Sleep disorders are fairly common in people with MS.   One study on sleep disorders in people with multiple sclerosis found that 36% of the test subjects with MS suffered from some form of sleep disorder. The study also found that age, sex, and degree of disability did not bear any direct relation with sleep disorders.  The only symptom of MS the study found that had a direct relationship to problems with sleep was depression.  Other studies on fatigue and sleep disorders in people with MS found that there was a significant correlation between fatigue in MS patients and disrupted sleep or abnormal sleep cycles.  It also found a relationship between excessive daytime sleepiness and fatigue in MS patients.  Some postulate that stress, spasticity, inactivity, and increased need to go to the bathroom also contribute to broken sleep patterns in people with MS.

Vertigo

While dizziness is common in people with MS, vertigo (sensation of spinning) is less so.   One study suggests that, “True vertigo is estimated to occur in about 20% of MS patients.”  Lesions in certain areas of the central nervous system can provoke vertigo in patients with MS.  This form of vertigo can be treated, but before that happens other possible forms of vertigo, such as benign paroxysmal positional vertigo (BPPV), should be checked for “in order to avoid unnecessary treatment with corticosteroids and vestibular suppressants.”¹¹

Seizures

Although seizures can occur in MS, they are fairly rare.  Some studies suggest that seizure incidence is the same as, or only slightly more than, the incidence for the general populace.  More than one study shows, however, that seizures in patients with MS can be correlated to alterations in their MRI and EEGs.  One study explains, “These images have shown that epileptic seizures can be caused by cortical and subcortical lesions and by their accompanying oedema.”   Most seizures can be controlled by medication.  According to one study on seizures in patients with MS, “Most of the patients with MS who experienced seizure activity had a benign and transient disorder that was responsive to antiepileptic drug treatment and required no therapy.”¹⁴

Pseudobulbar Affect

Pseudobulbar affect is pathologic laughing and crying, sometimes also called “emotional incontinence”.  Some studies suggested that this syndrome may be caused by dysfunction of the prefrontal cortex.   One doctor explains, “The frontal lobes are involved in judgment, social propriety and planning, among other things.  When pathologic laughter is seen, other cognitive functions also tend to be lost.” This syndrome has been regulated with Elavil and similar drugs.  Fluoxetine has also been used very successfully and a new drug, Neurodex.

Conclusion

Because MS is so variable, it is often difficult to diagnose – esp ecially when the presenting symptom is one not often associated MS.  Yet most of these “unusual symptoms” have at least one documented case showing that symptom as the first MS symptom experienced.  Both doctors and patients should be aware that these symptoms can be related to MS, and almost all can be controlled with the proper treatment.  People experiencing these symptoms should discuss them with their doctors and work together to find the best solution for the unusual symptoms of MS.

(1)  per·i·aq·ue·duc·tal adj.