multiple-sclerosis-differential-diagnosis-scaled.jpg

Multiple Sclerosis (MS) is a chronic neurological disease that affects the central nervous system and attacks the healthy tissue, just like a virus or bacteria. When the myelin sheath around the nerve fibers is damaged in multiple areas, it leaves a scar. Several scars or lesions like these, cause the nerve fibers to break or become damaged, thereby disabling the body from carrying out certain functions. Let’s take a look at some of the MS symptoms, MS diagnosis, and the differential diagnosis for multiple sclerosis.

Understanding Multiple Sclerosis

Multiple sclerosis is an acquired idiopathic, inflammatory demyelinating disorder of the central nervous system (CNS) in which the myelin sheath is disrupted due to genetic and environmental factors. The affected areas include the brain stem, cerebellum, spinal cord, optic nerves, and white matter in some areas of the brain. This can lead to behavioral changes, problems with mobility and balance, fatigue, pain, bowel problems, and depression.

Multiple Sclerosis Symptoms

Given that MS affects the brain and the spinal cord, which in turn, controls all the actions of our body, some of the earliest symptoms include: 

  • Muscle weakness
  • Numbness and tingling in the face, body, arms, or legs
  • Lhermitte’s sign (a shock-like sensation when they move their neck)
  • Difficulty emptying their bladder or need to urinate frequently 
  • Bowel problems and constipation
  • Fatigue, vertigo or hampering a person’s ability to function at work 
  • Sexual dysfunction 
  • Spasticity and muscle spasms
  • Double or blurred vision, or even partial or total loss of vision
  • Emotional changes or mood changes

The symptoms, intensity, and duration may differ from person to person, and over the course of the disease, may also depend on the amount of nerve damage and which nerves are affected. For some, it starts with a subtle sensation, and their symptoms do not progress for months or years. For some others, the symptoms can worsen rapidly, within weeks or months. In the later stages, people may also experience changes in perception and thinking, as well as sensitivity to heat.

MS Diagnosis

The diagnostic criteria for multiple sclerosis has been evolving since the 1950s, and to a large extent, the diagnosis primarily depends on the medical history and neurological examinations. Clinical findings that may be seen in MS, can also be mimicked by some infectious, neoplastic, genetic, metabolic, vascular, and other idiopathic inflammatory demyelinating disorders (IIDD). The aim of all the defined criteria is to establish the dissemination in space and time of the clinical picture caused by the lesions in the central nervous system (CNS) and to rule out other diseases which might mimic MS. 

Multiple Sclerosis Differential Diagnosis

In most cases, diagnosing Multiple Sclerosis is difficult. Clinical evidence of lesions disseminated in time and space and/or spinal fluid changes, usually leave little reason for doubt. However, a rogue ESR rate or an unexpected symptom of a fever, rash, or headache gives rise to doubt, resulting in the study of a differential diagnosis for multiple sclerosis. One of the most important paraclinical tests to confirm the diagnosis is Magnetic resonance imaging (MRI). This can both present the nature of the lesions (inflammatory and demyelinating characteristics) for differential diagnosis, and the distribution of the lesions within the CNS.

This noninvasive kind of imaging test is used to detect MS activity in the brain and spinal cord by healthcare professionals. Given that It is the best imaging tool available to both diagnose and monitor Multiple Sclerosis, MRI findings have notably shown that over 90% of people with an MS diagnosis have had it confirmed by this scan. It is safe, non-invasive, and can detect MS activity early on, sometimes even before an individual experiences any worsening symptoms. Healthcare professionals may use a chemical contrast dye called gadolinium to improve the brightness of MRI scan images, which is injected into a person’s vein just before the scan starts.

Multiple Sclerosis Treatments

Treatments such as stem cell therapy, physical therapy, and aerobic exercises can greatly help in slowing the progression of the disease, thereby reducing the number and the severity of the relapses. Autologous Stem Cell Therapy has shown considerable promise in reducing the symptoms and increasing the time between MS relapses. As part of their treatment, patients may also need to intensify the Physiotherapy and Occupational Therapy that they were undergoing for Multiple Sclerosis.

Primary treatment options normally include medications to delay the disease progression, that may be given orally, by injection, or as an infusion by your doctor. The duration and frequency of the treatment depend on the drug, its application, and if there are any adverse effects.

Doctors may also recommend mobility aids like walkers and wheelchairs to get around safely.  Exercise for Multiple Sclerosis can also be extremely beneficial to improve the overall fitness, endurance, and strengthening of muscles. 

FAQs

What mimics multiple sclerosis?

Fibromyalgia, Neuromyelitis Optica Spectrum Disorder (NMOSD), Small vessel ischemic disease, Sarcoidosis, Vitamin B12 deficiency, migraines, Spondylopathies, Conversion, and psychogenic disorders, Vasculitis, Acute Disseminated Encephalomyelitis (ADEM) mimics the symptoms of MS.

There are also multiple infectious entities that mimic MS, that include progressive multifocal leukoencephalopathy (PML), Toxoplasmosis, Tuberculosis, Herpes Simplex Virus, Cytomegalovirus, Varicella zoster virus, Epstein Barr virus, Cryptococcus, and Human immunodeficiency virus.

What can mimic MS on an MRI?

Migraines and chronic cerebrovascular diseases, cerebral autosomal dominant arteriopathy with subcortical infarcts, and leukoencephalopathy (CADASIL) can very easily mimic MS on an MRI. Furthermore, vasculitic autoimmune diseases such as systemic lupus erythematosus (SLE) and Sjögren’s syndrome can lead to white matter abnormalities on MRI.

Does MS have a positive ANA test?

An antinuclear antibodies test (ANA) can produce positive results, which means that antinuclear antibodies were found in your blood. However, it is also noteworthy that a positive result does not necessarily mean that you will have MS; it is purely an indicator.

How do you rule out MS?

A spinal tap (lumbar puncture) and blood tests usually help to rule out MS on a preliminary level, or the symptoms similar to MS, followed by medical history, neurologic exam, and lab tests that confirm the absence of MS.

What other symptoms have MS but no lesions?

Common symptoms like numbness, vertigo, fatigue, cystic acne, body spasms, or even burning feet can lead to MS, without any lesions showing up in the scan. 

Getting a correct diagnosis of Multiple Sclerosis (MS) can be a challenge. Not everyone might have all the common symptoms of MS, and some of the symptoms might also resemble those of some other conditions, such as Sjögren’s syndrome, Behçet’s disease, optic neuritis, “Idiopathic” transverse myelitis, Foix-Alajouanine syndrome, or clinicopathological variants like Marburg disease. Identifying MS and determining the final diagnosis is vital to knowing the right treatment choice to be able to prevent any long-term disability. 

Reference links:

https://www.medicalnewstoday.com/articles/ms-mri

https://www.nationalmssociety.org/For-Professionals/Clinical-Care/Diagnosing-MS/Differential-Diagnosis

https://jnnp.bmj.com/content/71/suppl_2/ii9

https://www.nationalmssociety.org/For-Professionals/Clinical-Care/Diagnosing-MS/Differential-Diagnosis

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.