MS Has Many Mimics, But What Makes MS Special?

Multiple sclerosis is a disease of nuances. It cannot be depicted by painting a few broad strokes in primary colors like a Fisher Price toy, then posted on social media and labeled an accurate artistic representation.  Knowing this, we can easily jump at the notion that more efficiently teasing out those nuances will clear the way to earlier diagnostic certainty, allowing our doctors to more quickly and easily sign a certificate of authenticity and, like a shotgun wedding at the local Justice of the Peace, swiftly pronounce us “patient and MS.” No rings necessary, just the requisite EVPs, spinal fluid analysis, and MRIs. Alas, this will likely never be the case. Here’s why.

MS Symptoms are consistent with symptoms of many other conditions

When, during the nuptials, the Justice asks the audience if anybody has a reason why these two shall not be joined in holy matrimony and to let them speak now or forever hold their peace, well, there’s going to be quite a line-up. There are so many other medical conditions that have the same symptoms as MS that the patient’s health might be in danger if she doesn’t subject herself to a long series of tests to rule out the numerous suitors clamoring for her hand in bondage. For example:

  • Hypothyroidism causes fatigue just like MS.
  • Lyme disease can cause dizziness, fatigue, numbness or tingling, spasms, weakness, walking difficulties, and vision problems, just like MS.
  • Conversion or psychogenic disorders can cause blindness or paralysis similar to MS.
  • Fibromyalgia causes muscle pain, headache, numbness or tingling, and fatigue.
  • Neuromyelitis optica is also a demyelinating disease that can cause many MS-like symptoms.
  • Lupus is another autoimmune disease that causes headache, muscle pain and headaches.
  • Stroke can cause vision loss, numbness in limbs, walking difficulty, speaking difficulty.
  • Sjögren’s Syndrome is also an autoimmune disorder that causes MS-like fatigue and pain.
  • Vasculitis can cause fatigue, joint pain, blurred vision, numbness, tingling and limb weakness.
  • Sarcoidosis is an autoimmune disease with like symptoms.
  • Myasthenia gravis is an autoimmune disease with a long list of like symptoms.
  • Acute disseminated encephalomyelitis (ADEM) very closely resembles MS but occurs more often in children than MS does.
  • Vitamin B12 deficiency can cause fatigue, mental confusion, numbness and tingling in hands and feet.

These are only 13 conditions among many, many more that can mimic MS. So if these symptoms are so common among so many diseases, what makes MS special?

By special we mean unique. So by that definition, MS is the only neurological, progressive autoimmune disease that is characterized by immune cells directly attacking the myelin coating of axons located in the central nervous system and causing damage to the brain, spinal cord and optic nerves.

Moreover, MS cannot be detected in a blood sample. Cerebrospinal fluid (CSF) is the only bodily fluid that will indicate a specific kind of evidence that inflammation is occurring within the central nervous system only and not in the rest of the body.

If you want a concise way to remember what distinguishes MS from other diseases that seem similar, here’s the most vital feature: A multiple sclerosis diagnosis is made when it can’t be anything else. It is a diagnosis of exclusion. A multiple sclerosis diagnosis is contingent on ruling out whole categories of other disorders.

These categories are listed on a National Multiple Sclerosis Society webpage as follows:

Infections of the Central Nervous System (CNS)

Includes Lyme disease, syphilis, progressive multi-focal leukoencephalopathy (PML), human immunodeficiency virus (HIV), human T-cell lymphotropic virus-1 (HTLV-1)/tropical spastic paraparesis.

Inflammatory disorders of the CNS

These disorders involve inflammation of the blood vessels and various other organs but do not involve nerve inflammation that is peculiar to MS. They include Sjögren’s, vasculitis, systemic lupus erythematosus (SLE), sarcoidosis, and Behҫet’s disease.

Genetic disorders

These include numerous hereditary conditions with obscure names. The most recognizable would likely be mitochondrial disease, a malfunctioning of the mitochondria (structures in cells that produce energy) that interferes with various body functions and can produce neurologic symptoms.

Brain tumors

Metastasized cancers are likely to spread to the CNS and cause neurologic systems; lymphoma is blood cancer that can spread to the CNS and cause tumors.

Deficiencies

Copper and B-12 deficiencies can cause neurologic symptoms.

Structural damage in the brain or spinal cord

Herniated spinal discs, where a collapsed disc can put pressure on a nerve root and cause neurologic symptoms; cervical spondylosis, aka degenerative spine disease that can cause neurologic symptoms when pressed on the spinal cord; Chiari’s malformation, an abnormality of the formation of the cerebellum where it sits too low and puts pressure on the brainstem or spinal cord, causing neurologic symptoms.

Non-MS demyelinating disorders

Neuromyelitis optica (NMO), aka Devic’s disease, is very similar to MS except that only 4000 people have it in the US compared to 400,000 MS cases. It primarily affects people between the ages of 40-50. It occurs in every part of the world, and it is the most common form of demyelinating disease among Africans, Asians, and Native Americans.

Another non-MS demyelinating disorder is acute disseminated encephalomyelitis (ADEM), which is often confused for a first attack of MS. Unlike MS, it can cause coma, it consists of only one acute attack and does not progress. It does not relapse and remit like multiple sclerosis.

As you can see, multiple sclerosis is not easy to diagnose. Making the “right marriage” between patient and diagnosis means proper treatment can be started as early as possible, preferably during the honeymoon. A shotgun wedding might bring immediate gratification, but the unhappy couple will soon know they got hitched way too fast.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
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