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Lauren Krupp, M.D., and Robert Charlson, M.D.

The Invisible Symptoms of Multiple Sclerosis

Many patients with MS have little or no apparent deficits at all on first glance

When people think about multiple sclerosis (MS), they often focus on the more apparent consequences of the more severe forms of the disease: the slow progression, or worsening, of a patient’s walking, the need for a cane or walker, or even worse. They often focus on the weakness and the falls.

Yet, the reality for many of our patients is something quite different. Many patients with MS have little or no apparent deficits at all on first glance, and coworkers, friends, and even some family might not have a clue that they have been diagnosed with the disease. But that does not necessarily mean the disease has spared them significant symptoms.

As a chronic disease that involves the immune system, MS has many effects on the whole body that impact quality of life. Perhaps the most prominent of these involve MS-related fatigue, depression, and cognitive impairment – a few of the so-called “invisible symptoms” of MS.

Interestingly, fatigue is often rated by people with MS as the most debilitating of all symptoms, even more than weakness or walking problems –a fact often surprising to the public and even physicians. It is a complex aspect of the disease in men and women, meaning that it doesn’t spring from damage to one part of the brain, and most studies have found strong correlations with depression and cognitive impairment, including problems with memory, problem solving, response time and recall. Indeed, these invisible symptoms can be thought of as “overlapping circles” – concepts that are difficult to completely separate from one another.

Importantly, while the effects of cognitive impairment, depression and fatigue in MS can be debilitating, even for patients who otherwise appear unaffected, there are treatments available. For example, many studies have found physical exercise and cognitive behavioral therapy to be helpful in both fatigue and depression in MS.

New research is also looking at other novel ways to treat these symptoms, including transcranial direct-current stimulation (tDCS), which we are currently studying at our MS Center.

Talking with your doctor about your MS symptoms – even the ones that can’t be obviously seen by others – is the first step toward dealing with these important symptoms of the disease.


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Lauren Krupp, M.D., and Robert Charlson, M.D., are on the faculty at NYU Langone. They are also with the NYU Langone Multiple Sclerosis Comprehensive Care Center.