You may wind up in a neurologist’s office if your primary care doctor suspects that you have multiple sclerosis. Maybe your symptoms led you there, or maybe it was the result of a magnetic resonance imaging brain scan. But that doesn’t mean you actually have MS, the progressive autoimmune disease that damages the brain, spinal cord and optic nerves.
Many people are sent to specialists when symptoms appear to indicate multiple sclerosis. “Patients come in and think they have MS, but often it turns out to be another problem,” says Dr. Dean Sutherland, a neurologist and clinical assistant professor at the Florida State University College of Medicine. “That’s because there are so many conditions that look like MS.”
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Overlapping Symptoms
MS often causes temporary attacks of weakness, blindness and sensory changes that happen over the course of a couple days. The National Multiple Sclerosis Society reports that common symptoms include fatigue, trouble walking, numbness and tingling, involuntary muscle spasms, weakness, vision problems, dizziness and vertigo, bladder and bowel problems, sexual dysfunction, pain, changes in thinking skills and depression. Less common symptoms include headache, hearing loss, itching, seizures, tremors and speech and swallowing problems.
Various combinations of those symptoms can be present in many other disorders. For example: “The most common symptom of MS is fatigue. But there are dozens [of] other conditions that also cause fatigue,” says Dr. Barbara Giesser, professor of clinical neurology and clinical director of the Multiple Sclerosis Program at the David Geffen School of Medicine at UCLA.
Other conditions may also mimic MS in diagnostic testing. For example, many disorders show up as spots on a brain MRI, just like MS.
The National Multiple Sclerosis Society lists two dozen common and rare conditions that should be ruled out before making a diagnosis of MS. These include:
Vitamin deficiency, such as B12, which is crucial for red blood cell formation and neurological function. “Too little B12 can cause the brain to look similar to multiple sclerosis. The white brain matter changes,” says Sutherland. Symptoms of B12 deficiency similar to MS include fatigue, difficulty maintaining balance, depression and numbness and tingling in the hands and feet.
Lyme disease, a bacterial infection transmitted by ticks. “It can cause spots on an MRI or spinal fluid abnormalities,” Giesser says. Symptoms similar to MS include fatigue, weakness and muscle aches.
Human immunodeficiency virus, or HIV, which attacks the body’s immune system. Similar symptoms to MS include weakness, spinal cord problems, fatigue, and spots on an MRI.
Autoimmune conditions such as lupus, which attacks the organs, skin and nervous system; Sjögren’s syndrome, which attacks the joints, nervous system and moisture glands; and sarcoidosis, which attacks the lungs, skin, lymph nodes, liver and nervous system. All of these disorders can present with debilitating fatigue and specific neurological symptoms, such as weakness, visual problems or sensory changes (such as numbness, tingling, prickling or burning sensations). “These conditions can cause nerve damage in the same areas as MS, and give similar symptoms and findings, but the way the nerve damage is produced is different than in MS,” Giesser says.
CADASIL (aka Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy), an inherited disease caused by a gene mutation that affects small blood vessels in the brain. “I’ve seen this cause neurological symptoms similar to MS, such as migraine headaches, seizures, vision problems and depression,” Sutherland says.
Brain tumors, which can cause many symptoms similar to MS, including headaches; vision, hearing or speech problems; difficulty with balance; and seizures.
Spine conditions, such as cervical stenosis, a narrowing of the space around the nerves or spinal cord; or a herniated disk, when part of the soft disk material leaks out, irritates the nerves or presses against the spinal cord, and causes neurological symptoms. “Anything that affects the spinal cord can cause weakness and affect bladder, bowel or sexual function,”Giesser says.
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Making the Distinction
With so many overlapping symptoms, how do doctors narrow down the possibilities and figure out what’s causing them?
It starts with a visit to a neurologist that includes a physical exam and a look at your medical history. Your doctor may order several tests including:
— An MRI of the brain and spinal cord.
— A spinal tap to check the fluid around your brain and spinal cord.
— An evoked potential, or EP, exam to measure electrical activity in the brain and electrical signals along the nerves.
Since MS isn’t the only thing that can cause abnormalities on these tests, it’s up to your doctor to then pinpoint the cause of your symptoms. “For example, I often see a patient with spots on an MRI. So I’ll look at the size and shape and distribution of the spots to see if they’re more suggestive of MS or more indicative of another condition,” Giesser explains.
Or your doctor will look at the pattern of MS symptoms. “MS can cause attacks of weakness, blindness or sensory changes that happen over the course of a couple days, and then get better. Other conditions, like B12 deficiency, take a long time to cause damage, and don’t cause acute attacks like MS,” Sutherland says. “Ruling out other causes is what helps us figure it out.”
Don’t Jump to Conclusions
If you feel you have symptoms of MS, or if your primary care doctor suggests that you do, try to reserve judgment until you can talk to a neurologist. The actual diagnosis may be something else.
[See: 10 Lessons From Empowered Patients.]
Sutherland has a long list of examples of patients he’s seen whose initial MS diagnosis from a primary care doctor was wrong. There was the young woman who’d been backpacking along the northeastern Appalachian Trail, and came home and developed severe fatigue and weakness in her arm. “She really had acute Lyme disease. She was treated and is now a triathlete,” Sutherland says. And there was the 52-year-old man struggling with cognitive (thinking skills) changes and migraine headaches. He’d been told he had MS after a suspicious MRI. “He actually had a rare type of migraine-like condition that ran in the family,” Sutherland says.
“We don’t have one slam-dunk test for MS,” Giesser adds. “We have to meet criteria for evidence of nerve damage in more than one place in the central nervous system, which occurs at more than one point in time, and make sure there’s no other condition that could have produced similar symptoms. It’s not MS until we satisfy these rules.”
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Before an MS Diagnosis, Rule Out These Conditions First originally appeared on usnews.com
