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cal disturbances. Examples of typical MS relapses include blurring of vision in one eye (optic neuritis), persistent numbness or tingling of a body part (sensory system relapse), weakness of a body part (motor system relapse), or loss of coordination (cerebellar system relapse). Early in the MS disease process, relapses are likely to involve sensory, motor, cerebellar, or visual system abnormalities ( Figure 2.2, Table 2.2). Later in the disease process, relapses are likely to involve bladder, bowel, cognitive, and sexual function abnormalities. Acute disease attacks are a characteristic feature of the relapsing-remitting MS subtype. Relapses also occur in patients with progressive relapsing disease and in a number of patients with secondary progressive disease. The only clinical disease subtype in which relapses never occur is primary progressive MS.

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FIGURE 2.2 Areas of the CNS often affected by MS. Reprinted with permission from University of Delaware.

TABLE 2.2 Initial Signs and Symptoms of MS



  • Sensory problems (numbness or tingling of a body part)

  • Weakness

  • Difficulty walking

  • Monocular decreased vision

  • Poor coordination

  • Bladder problems

  • Bowel problems

  • Sexual dysfunction

  • Cognitive difficulties

  • Pain

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