MS Young Adults: Age of Onset and Early Symptoms - Verywell Health

Young adulthood is a time when individuals are typically enjoying independence and exploring new careers, passions, and relationships. Unfortunately, the 20s to 30s age range is also when multiple sclerosis (MS) is most likely to strike.

In MS, a person's immune system attacks the fatty covering (myelin sheath) of nerve fibers within their central nervous system (CNS). The CNS consists of your brain, spinal cord, and the optic nerves of your eyes.

The damage to myelin, known as demyelination, impairs nerve signaling between the CNS and the rest of the body. Depending on where the demyelination occurs, symptoms like numbness, fatigue, weakness, and vision disturbances can arise.

In this article, we'll explore the manifestation of multiple sclerosis in young adults, from symptom onset and progression to diagnosis and treatment.

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MS Age of Onset

MS is most commonly detected between the ages of 20 and 40. However, the disease can occur at any age. Less than 1% of cases occur in childhood (called pediatric MS), and around 2% to 10% of cases occur after 50 years of age (called late-onset MS).

A Delayed or Wrong Diagnosis

Even after MS symptoms develop, it can take years for a person to be diagnosed. The reverse is also true—nearly 1 in 5 people are misdiagnosed with MS.

Early Symptoms of MS

There is no single neurological symptom or sign that is unique to MS, and this remains true whether a person is diagnosed with MS as a child or adult. That said, there are features that are highly characteristic of the disease.

As an example, optic neuritis is a common first manifestation of MS in young adults.

Optic neuritis refers to inflammation of the nerve that transmits messages to your brain about what your eye sees. It causes diminishing vision in one eye that worsens over hours to days, as well as pain in or around the eye.

Other symptoms that may serve as early warning signs of MS in young adults include:

MS Diagnosis in Young Adults

Regardless of age, the diagnosis of MS is oftentimes challenging. This is because MS symptoms vary greatly from person to person, and some of them resemble those of other health conditions. There is also no single blood or imaging test that can confirm a diagnosis of MS.

To help neurologists (specialists in conditions affecting the nervous system) diagnose MS accurately and timely, experts created a formal set of guidelines called the McDonald criteria.

To fulfill the McDonald criteria, a person must have evidence of damage in at least two different parts of their CNS, and this damage must have occurred at different times.

Neurologists use several diagnostic tools and tests to determine if the McDonald criteria are met:

Stages of MS Development

MS is sometimes described in stages, as a young adult may naturally advance from one MS type to another.

Clinically isolated syndrome (CIS) refers to a person's first episode of MS symptoms. The symptoms of CIS last more than 24 hours and eventually go away, either partially or completely.

What's tricky and somewhat confusing is that CIS is not technically MS. This is because CIS doesn't meet the McDonald criteria, which states that MS damage must occur on different dates. It's important to understand that not everyone with CIS will go on to develop MS.

Those with CIS who do go on to experience a second episode of MS symptoms are diagnosed with relapsing-remitting MS (RRMS).

RRMS is the most common type of MS and is characterized by relapses ("flare-ups") of new or worsening MS symptoms and periods of symptom stability (called remission).

Many people with relapsing-remitting MS (RRMS) eventually shift to a progressive form of the disease called secondary progressive MS (SPMS). In SPMS, symptoms slowly build up and worsen over time.

What Is Primary Progressive MS?

Primary progressive MS (PPMS) affects around 15% of people with MS. It's different from SPMS because it's characterized by slowly worsening MS symptoms from the onset of the disease, without early relapses.

In the final stages of MS, sometimes called advanced MS, people experience most of the same symptoms as those in the early stages (CIS, RRMS, and/or SPMS). However, their symptoms are more severe, and the accumulation of their symptoms results in significant disability.

People with advanced MS are usually in a wheelchair or bedbound and dependent on others for their personal and health-related needs.

MS Treatment in Young Adults

As with pediatric or late-onset MS, there is no cure for MS in young adults.

There are, however, multiple disease-modifying therapies (DMTs) available that can help slow the course of the disease and reduce relapses.

DMTs vary in how they work, their safety profiles, and their route of administration (e.g., by injection, mouth, or intravenous infusion). Selecting a DMT depends on several factors like your MS type, your disease's severity, and whether you have other health problems.

Starting a DMT Soon After Diagnosis

Research indicates that early treatment with DMTs plays a key role in delaying disability and probably improves a person's long-term outlook.

It's important to understand that DMTs do not treat MS relapses or symptoms. Moderate to severe MS relapses are typically treated with a corticosteroid, whereas MS symptoms are treated with various targeted therapies like medications and rehabilitation strategies.

Prognosis

MS is not a fatal or terminal disease. In fact, research suggests that around 90% of people diagnosed with MS in their 20s may live into their 70s. The increase in lifespan over the past two decades for people with MS has largely been attributed to the emergence of disease-modifying therapies.

Other non-MS-related factors also affect a person's longevity, such as:

• Genetics
• The presence of other health conditions (e.g., diabetes and heart disease)
• Lifestyle (e.g., smoking and nutrition)
  

Summary

Even though MS can develop at any age, it's most commonly diagnosed in young adults, between the ages of 20 and 40. While the symptoms of MS vary considerably in type and severity from person to person, there are some symptoms—vision disturbances, numbness, and tingling—that tend to crop up early on in the disease.

To diagnose MS, your healthcare provider will analyze the results from your medical history, physical exam, and MRI of your brain/spinal cord (among other tests). Once diagnosed, treatment with disease-modifying therapy is essential to optimizing a person's long-term outlook living with MS.

A Word From Verywell

Being diagnosed with MS at any age can be gut-wrenching. For young adults, a diagnosis may greatly impact the life and dreams they once imagined for themselves.

The good news is that with the right care (which usually involves disease-modifying therapy), support from others, and a resilient mindset, most people learn to adapt and fully embrace their lives with MS.

Frequently Asked Questions

• MS is most commonly diagnosed in young adults between the ages of 20 and 40. According to the National MS Society, nearly 1 million people in the United States live with MS.

• MS affects everyone differently—however, there are some common initial symptoms or signs of the disease, such as blurry vision from optic neuritis, numbness, tingling, weakness in the legs, and fatigue.

• There is no cure for MS, even if it's caught early. There are disease-modifying medications that can help slow the course of the disease and reduce relapses.

• Possibly. Research suggests that people diagnosed with MS after age 50 become disabled at a faster rate compared to adults diagnosed with MS before age 50.