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Is it MS? Choices booklet

It may be that you, or someone you know, has been experiencing some symptoms and are anxious as to what these could be? They might be the kind of symptoms that give you the suspicion that it could be multiple sclerosis (MS).

It must also be said that whilst on a journey towards a diagnosis of MS, many people’s symptoms are often misdiagnosed as a different condition (1).

It is also important to note that there are many neurological conditions whereby symptoms are very similar, so what might first be thought of as symptoms of MS, may well be symptoms of another condition entirely. This leaflet provides an insight into some of what those may be.

It is important to remember that this leaflet provides guidelines and general information and should not be used to self-diagnose. Anyone with symptoms affecting their health and general wellbeing are advised to always seek appropriate medical advice from a health professional.

If you believe your symptoms are of a neurological origin, it is worth keeping a symptom diary, updating it regularly and presenting this to your health professionals each time you meet them. This may help them to see the bigger picture and treat you holistically rather than looking at symptoms in isolation.

Many people spend a long time trying to achieve a diagnosis of any kind. If your undiagnosed condition is causing symptoms that are affecting you and giving you problems you should still be entitled to help from health and social care services even without a formal diagnosis.

MS is a condition that exhibits many similar symptoms to a variety of other conditions as we will explore in this leaflet. If MS has been ruled out, it could be that you may wish to explore the possibility that one of these conditions could be the root cause of your symptoms.

Although it may feel like a journey where you keep going backwards and forwards to your GP it is always worth speaking to them about how you feel, with a list of questions you wish to ask and a copy of your symptom diary if possible. If you are being made to feel like a problem patient or do not feel you are being listened to, yet are certain that the symptoms are real, it would be reasonable to ask for a second opinion.

Acute Disseminated Encephalomyelitis

Acute Disseminated Encephalomyelitis (ADEM) is a rare demyelinating condition which is thought to be autoimmune in nature. ADEM and MS can be difficult to distinguish initially. It usually affects children under ten years old.

ADEM presents with a rapid onset of symptoms - headache, drowsiness and stiff neck – accompanied by the more typical neurological symptoms of optic neuritis, balance problems and walking difficulties. Occasionally the person may have a seizure. Unlike MS, ADEM tends to occur only once, for a few days and often resolves itself without treatment, although antibiotics may be given as a precaution until bacterial infection is ruled out, accompanied with intravenous steroid to reduce the inflammation in the brain.

Symptoms of ADEM which are similar to MS are

  • Optic neuritis
  • Balance problems
  • Difficulty with talking

Amyotrophic Lateral Sclerosis

The most common form of Motor Neurone Disease (MND) is Amyotrophic Lateral Sclerosis (ALS) or, as it is often referred as, ‘Lou Gehrig’s Disease’. ALS is a degenerative condition affecting the motor neurons in the brain and spinal cord. As the condition progresses and the motor neurons degenerate, muscle control is lost resulting in a difficulty with swallowing, speech, movement and breathing.

In the early stages of ALS, symptoms which are similar to MS are

  • Muscle weakness or stiffness in the hands, arms, legs
  • Difficulty with speech, swallowing and breathing
  • Twitching and cramping of muscles

Fibromyalgia

Fibromyalgia is a long-term (chronic) condition that causes widespread muscular pain. It is thought that as many as 1 person in every 25 may experience it. More women than men are affected and the condition varies a great deal from one person to another and from day to day. One important fact to note is that it does not show up on an MRI.

Symptoms of fibromyalgia which are similar to MS are

  • Fatigue
  • Joint and muscle pain
  • Bowel problems
  • Increased sensitivity to hot and cold
  • Cognitive problems
  • Headache
  • Numbness and tingling in the extremities

Hughes Syndrome

Hughes Syndrome is a blood disorder which in some ways mimics MS. Also known as ‘sticky blood syndrome’, Hughes is a common autoimmune disease that makes the blood more thick or ‘sticky’ and therefore more prone to clotting in the veins or arteries.

Some of the symptoms of Hughes Syndrome which are similar to MS are

  • Mobility - difficulty in walking, tripping or dragging foot
  • Double vision
  • Fatigue
  • Balance
  • Speech

Hughes Syndrome is easy to diagnose by a simple blood test and easy to treat with blood thinning medication such as warfarin or aspirin.

Lupus 

Lupus is a disease of the immune system. Like MS, the immune system gets confused and begins to attack itself. With Lupus, however, this causes the blood stream to have too many antibodies, which leads to inflammation and damage in the joints, muscles and other areas. It affects more women than men. Some people do not have its typical rash and arthritis straight away, making symptoms seem even more like MS.

Some of the symptoms of Lupus which are similar to MS are

  • Extreme fatigue
  • Weakness
  • Joint and muscle aches and pains.
  • Migraines

Lyme disease

Lyme disease is an infection of the central nervous system (CNS) caused by bacteria from a tick bite. If you live in an area known for Lyme disease or have travelled to a known area recently, let your doctor know so that they can rule it out.

Some of the symptoms of Lyme disease which are similar to MS are

  • Numbness
  • Pins and needles
  • Poor balance
  • Difficulty walking
  • Tremor
  • Problems with vision
  • Fatigue
  • Headache
  • Muscle and joint ache

ME/CFS (Chronic Fatigue Syndrome) 

Someone with ME/CFS is so fatigued that it impacts on their daily life. It is still unknown what causes ME/CFS although it sometimes follows an illness and some researchers believe that ME/CFS could be due to a reaction to common viruses.

Some of the symptoms of ME which are similar to MS are

  • Fatigue
  • Chronic pain
  • Cognitive problems

Myasthenia Gravis 

Myasthenia Gravis is a rare autoimmune condition that causes weakness in the muscles that control voluntary movement – particularly muscles in the face, meaning chewing, swallowing, talking, eyelid and eye movement, and facial expression can be affected. Muscles controlling limb movement and breathing can also be affected. Muscle weakness is exacerbated by physical movement. The difference between MS and MG is MS is an autoimmune disorder of the central nervous system (CNS) and MG is a disorder of the skeletal muscles. There is no cure for Myasthenia Gravis but treatments are available to manage the symptoms and control muscle weakness.

Symptoms of Myasthenia Gravis which are similar to MS are

  • Fatigue
  • Muscle weakness
  • Double vision

Neuromyelitis Optica (NMO or Devic’s disease)

NMO is a very rare condition. In Europe, it is estimated that there is one case of NMO for every 100,000 people, potentially affecting less than 1000 people in the UK.

NMO can affect any age group and is predominantly a female disease with only 1 man being affected to every 4 women. Neuromyelitis is very similar to MS in that it is a disease of the nervous system where there are episodes of myelin damage. In NMO however this inflammation is almost always in the optic nerves and spinal cord.

Some of the symptoms of NMO which are similar to MS are

  • Vision problems (including temporary or permanent blindness in one or both eyes)
  • Weakness of limbs
  • Loss of sensation
  • Bladder and bowel problems

Sarcoidosis

Sarcoidosis is a rare condition that causes small patches of red and swollen tissue, called granulomas, to develop in the organs of the body. However, the skin is only affected in 25% of people with sarcoidosis. However, every person is affected differently and symptoms depend on which organs are affected. Sarcoidosis can affect the brain but usually starts in the lungs.

Some of the symptoms of Sarcoidosis which are similar to MS are

  • Decreased vision
  • Numbness
  • Muscle weakness
  • Bladder and bowel problems

Sjögren’s Syndrome 

Sjögren’s Syndrome is an autoimmune condition where the body attacks glands which produce moisture in the body – the tear ducts and the salivary glands.

Causes of Sjögren’s Syndrome are unknown, although it is linked to genetic and environmental factors. The condition is more common in women. What makes it different from MS is inflammation of the glands which can cause dry mouth and dry eyes. There is no cure for Sjögren’s Syndrome, but treatments to keep the mouth and eyes wet, such as artificial tear drops and artificial saliva spray, can help to manage the symptoms.

Some of the symptoms of Sjögren’s Syndrome which are similar to MS are

  • Problems with chewing, swallowing and talking
  • Fatigue
  • Musculoskeletal pain
  • Difficulty walking, balance difficulties
  • Numbness and tingling

Transverse Myelitis (TM) 

Transverse Myelitis is a disease of the central nervous system. Like MS it involves inflammation, however in TM the inflammation is on the spinal cord.

Some of the symptoms which are similar to those of MS are

  • Weakness
  • Loss of sensations
  • Bladder & Bowel problems

Vitamin B12 Deficiency (also known as Folate Deficiency Anaemia)

Vitamin B12 aids the metabolism of fatty acids needed to maintain the myelin sheath which protects the axons (nerve fibres) in the brain and spinal cord. It can be identified by a simple blood test.

Some of the symptoms of B12 deficiency which are similar to MS are

  • Fatigue
  • Memory loss

This content is taken from the MS-UK Choices booklet. 

Visit the Choices booklet web page