Coordination difficulties mark acute episodes of multiple sclerosis.

Let me paint a quick scene. A patient with multiple sclerosis is in the hospital corridor, and you notice their step isn’t as steady as it should be. They reach for a doorknob and miss it a little, their arm lacks its usual precise control, and their gait stumbles just enough to raise your eyebrows. You ask a simple question in your mind: what’s happening during this acute flare, and which symptom truly signals that something is changing right now? Here’s the thing you’ll want to hold onto: coordination difficulties are a hallmark of an acute episode in MS. It’s the red flag that often tells the story first.

What happens during an acute MS flare?

Multiple sclerosis is a disease of the nervous system that loves to remind you how finely tuned your body’s signals really are. In an acute flare, the immune system briefly attacks the myelin—the insulating sheath around nerve fibers. When myelin is damaged, the nerves can’t shout their messages as fast or as accurately as they usually do. The result is a patchwork of neurologic deficits that can pop up suddenly and vary from person to person.

The core problem during an acute attack is disrupted signaling along pathways that control movement and balance. Think of it as a city where a few major streets are closed for repairs. Cars (the nerve impulses) can still get through, but the route is slower, more winding, and sometimes prone to detours. That’s why so many patients report a sense of clumsiness or unsteadiness during an exacerbation.

Coordination difficulties—the star player in the acute phase

Coordination difficulties arise from interruptions in motor pathways—especially those that govern how the brain plans and carries out smooth, coordinated movements. In MS, messages that travel from the brain to the muscles to direct posture and precise movements get scrambled just enough to cause:

• Unsteady gait or ataxia: you might see a staggering walk, foot slapping, or an uncoordinated placing of the feet.

• Difficulty with fine motor tasks: buttoning a shirt, zipping a zipper, or writing can become noticeably awkward.

• Problems with rapid alternating movements: tapping fingers or rapidly turning a doorknob may feel hesitant or sloppy.

• Dysmetria and intention tremor: overshooting or undershooting a target (like touching your nose) and tremors that appear as the patient tries to reach something.

Why isn’t memory or sleepiness the same red flag here?

Impaired memory, excessive sleepiness, and vision problems do appear with MS, but they don’t always point to an acute, on-the-spot disruption of motor control the way coordination difficulties do. Vision loss, for example, often stems from optic neuritis and can be dramatic—but it’s a different thread in the MS tapestry. Coordination difficulties, by contrast, map closely to the immediate breakdown in motor pathway communication that defines an acute episode.

Let’s unpack that a little. The brain’s motor plan starts in areas like the cerebellum and motor cortex. It then travels down through the brainstem and spinal cord to reach the muscles. In MS, demyelination disrupts the speed and precision of those signals. When those pathways falter, the brain’s “dance routine” becomes imperfect. You don’t need to memorize every neuron, but you do want to recognize that this is a problem of timing, precision, and balance—precisely what clinicians look for during a neurologic assessment in an MS flare.

What this means for patient care and observation

If you’re taking care of someone with MS during an acute episode, coordination issues aren’t just a curiosity—they’re a safety concern and a cue about the patient’s needs. Here are practical angles to keep in mind:

• Safety first: near-falls are common during coordination problems. Keep the environment clear of obstacles, use assistive devices as prescribed, and ensure the patient wears footwear with good grip.

• Assess systematically: note gait pattern, sway, the ability to perform fine motor tasks, and the patient’s reported level of difficulty with daily activities. A quick bedside screen can reveal whether coordination issues are focal (e.g., a tremor in one hand) or more generalized.

• Document with clarity: when you record findings, link the symptom to functional impact. For example, “gait instability with mild ataxia observed during ambulation; difficulty with rapid finger tapping and coin grip strength.”

• Coordinate with rehab teams: PT and OT can tailor interventions to improve balance, coordination, and dexterity, while also teaching strategies to conserve energy and reduce fatigue.

• Fall risk and safety planning: educate on safe transfers, the use of assistive devices, and environmental modifications at home if discharge is part of the plan.

A quick digression that still loops back

Here’s a little real-world sense-making moment. In clinical rounds, you’ll hear clinicians describe MS symptoms as a mosaic that changes with each flare. Some days the patient may feel unusually spry, other days they stumble. The same person can present with vision disturbances on one visit and prominent coordination problems on the next. That variability isn’t a contradiction; it’s the disease’s rhythm. Understanding that rhythm helps you prioritize which symptom to address first when you’re charting care plans or discussing priorities with the team.

Related signs you might encounter during an acute episode

While coordination difficulties stand out, other neurologic signs often accompany an MS flare. Being mindful of how these symptoms interact helps you read the room—whether you’re a student, a nurse, or a future clinician.

• Sensory changes: numbness, tingling, or a “pins and needles” feeling can travel along limbs or the face.

• Weakness: mild leg or arm weakness may reinforce the sense of unsteadiness.

• Blurred vision or eye discomfort: optic neuritis may appear, sometimes with pain when moving the eye.

• Fatigue: many patients describe a profound sense of fatigue that makes coordination work harder.

• Dizziness or vertigo: balance may feel off, compounding motor difficulties.

How to talk about it clearly with patients and families

A big part of nursing care is communication. When a flare hits, patients and caregivers want straight answers and practical steps.

• Use plain language: “You’re having more trouble coordinating your movements today” is easier to grasp than “there’s a focal demyelinating event in the motor pathways.”

• Set expectations gently: explain that nerves are recovering in some areas but may still be damaged in others, and the goal is to prevent injury and maintain independence as much as possible.

• Share safety tips: sit when needed, arrange the room to reduce trip hazards, and encourage the use of assistive devices if recommended.

A few words on the bigger picture

Coordination difficulties during an acute MS flare aren’t just a single symptom; they’re a window into the nervous system’s intricate choreography. They remind us that good care hinges on recognizing how quickly a patient’s neurologic status can shift and how essential it is to tailor interventions to the current snapshot of function. For nurses, students, and clinicians, that awareness is a compass—guiding assessments, documenting accurately, and coordinating care that keeps people safe and moving forward.

Putting it all together: quick takeaways you can remember

• The hallmark symptom of an acute MS episode is coordination difficulties.

• This reflects disrupted signaling in motor pathways, often manifesting as ataxia, unsteady gait, and reduced fine motor precision.

• Other symptoms like memory changes, sleepiness, or vision problems can occur, but they don’t define the acute motor disruption the same way.

• Safety, systematic assessment, and collaboration with rehab specialists are key to supporting patients through an eruption of symptoms.

• Understanding the role of coordination helps you connect what you see at the bedside with the underlying neurobiology—demyelination and its impact on motor function and balance.

If you’re studying the NCLEX Neurologic and Sensory Systems, you’ll notice how coordination, balance, and motor control often show up as a triad during acute episodes. It’s not just about memorizing a single symptom; it’s about appreciating how the nervous system’s timing can go off-kilter and what that means for care. And yes, while this is a medical topic, it’s also a human story—a person trying to navigate a moment when their own body feels a little unfamiliar. Keeping that balance—the clinical why and the human how—will help you connect with patients, explain things clearly, and act with confidence when it matters most.

If you’d like, we can dig into real-world scenarios or go through a quick symptom checklist you can use during rounds. After all, in a field that blends science with everyday lived experience, practical understanding often makes the difference between hesitation and decisive, compassionate care.