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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.

  1. Silver N. Is It Lyme Disease or Multiple Sclerosis (MS)? Learn the Signs. Healthline, December 14, 2015. www.healthline.com/health/symptoms-of-lyme-disease-and-ms
  2. Orenstein B. 13 Conditions Commonly Mistaken for Multiple Sclerosis: Many disorders share symptoms with MS, sometimes complicating its diagnosis. Everyday Health, last updated on 9/13/2016. www.everydayhealth.com/multiple-sclerosis/symptoms/conditions-commonly-mistaken-multiple-sclerosis
  3. Rolak Loren A. Multiple Sclerosis: It’s Not the Disease You Thought It Was. Clin Med Res., 2003 Jan; 1(1): 57–60. www.ncbi.nlm.nih.gov/pmc/articles/PMC1069023
  4. Other Conditions to Rule Out. National Multiple Sclerosis Society. www.nationalmssociety.org/Symptoms-Diagnosis/Other-Conditions-to-Rule-Out

Comments

  • pippa
    1 month ago

    How can one test for Lyme Disease?
    I have always had dogs and cats around me…maybe…
    Although I haven’t heard too much about it here in Israel.
    Maybe, just maybe I DON”T have MS…. it could be, as you say, something else

  • pippa
    1 month ago

    I am now 75…..can’t really believe it myself.
    After more than 6 years injecting Copaxone in my legs……. I am well and truly fed up with the added craters and bumps. to show for it.
    Does it actually help? I don’t know… but I DO know that I am stopping.
    Are there side effects to stopping? Any comments?

  • Kim Dolce moderator author
    1 month ago

    @pippa, I stopped Copaxone after four years. I had a flare at that point (in 2009) and asked the neuro for something else. I too developed welts and craters–in thighs and back of arms–as well as hard painful-to-inject areas in my thighs rendering them unusable and I was reduced to using hips and tummy.

    I suffered no ill effects from stopping. From Copaxone I went to Rebif briefly but the injection was terribly painful, so on to monthly Tysabri infusions for a year. My tiny hard-to-find veins made infusions a day-long affair with many failed punctures so I abandoned that. After two years with no drugs, Tecfidera, a pill, came on the market and I’ve been on that for six years.

    I don’t blame you for getting off injectables. There are many options out there now and I hope you’ve discussed them with your doc. Please update us on what you’re taking now, if anything. Thank you so much for telling us your experience! Looking forward to hearing from you again 🙂 Best, Kim, author and moderator

  • Tess
    1 month ago

    I had a Herniated Spinal disc; 2 in fact. C5-6 level. Took a year of tests, poking, prodding, experimentation failures for insurance company to approve fusion surgery. Result: permanent nerve damage. Thanks for that Big Pharma and Corps!

  • Toddlius
    1 month ago

    Thank you Kim. I had heard of a few of these chronic conditions, but not all. Thank you for doing so much research.

    Todd

  • RobWelsh
    1 year ago

    I have a black hole in my brain. How does that happen, medically speaking?

  • Kim Dolce moderator author
    1 month ago

    @robwelsh, sorry I’m getting back with you a year late, man! A black hole means cell death, permanent, irreversible axonal damage. It’s also called a “hypointensive lesion” on your MRI radiology report, indicating it shows up as a dark area, as opposed to a bright white “hyperintensive enhancing lesion” of new damage to the myelin coating. The bummer about those black holes is that over time it contributes to brain shrinkage, or “atrophy.” That of course is a bad thing. Hope this finds you well and your MS relatively stable. Best, Kim, author and moderator

  • RobWelsh
    1 month ago

    A black holes is a metaphor of mystery, nuff said.

  • Julie
    3 years ago

    I just wanted you to know I always enjoy your posts. They are so well thought out and researched. You did forget to tell me where I can go to get a divorce from this damn MS! LOL

    Seriously, I have been DX’d for almost 16 years now, I spent the first 10 years asking my neuro if he was sure it was MS. I know I was there for all the tests and results. I really just wanted it to be something else, preferably something that can be cured.

    I’m also curious if you can have MS and something else? Can you have more than one neurologic disorder? And how can they tell what 2 or more you might have?

    Thanks always for giving me pause to think about my MS in a different way.

  • Tess
    1 month ago

    I call MS the Monster Beast. When you find that divorce attorney…let us know.

  • Kim Dolce moderator author
    3 years ago

    Hi Julie, thanks for the kind words. Sorry I don’t know any disability lawyers who are experts on disease annulments, but hey, wherever there’s a need, some shyster will find a way to fill it 🙂

    It’s safe to say a significant majority of us will develop at least one other autoimmune disorder before we croak. Autoimmune thyroid disease seems to be a common one. If you’d like to read more about MS and comorbidities, we have some articles on MS.net that mention that relationship, just type comorbidities into the search box. Coincidentally, I’ll be writing an article soon about that very subject.

    Thanks for including some of your dx history, it always helps our readers gauge how common our experiences really are with this disease. Hope you’re doing okay 🙂

    Kim

  • Tess
    1 month ago

    Love your reply Kim. Awesome!

  • jennyb
    3 years ago

    Psoriatic arthrits was not mentioned. Fatigue, pain, and all sorts of things. I sometimes can’t tell one from the other.

  • Kim Dolce moderator author
    3 years ago

    Hi Jenny, what a bummer to have both medical conditions! After watching “The Singing Detective,” I developed a lot of sympathy for you all who have psoriatic arthritis. I hope you have some good tools to manage your symptoms. Thanks so much for commenting and sharing you personal history. Our readers do so appreciate knowing they aren’t alone.

    Kim

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