Alternative Diagnoses to Multiple Sclerosis

Clues That You Do or Do Not Have MS

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Multiple sclerosis (MS) has numerous symptoms, many of which are vague, difficult to describe, cannot be measured by tests, and come and go. In addition, many MS symptoms are not specific to MS, meaning they are also a symptom of another medical condition. This can make the diagnosis of MS challenging. 

However, this challenge works both ways, meaning that people may think they have MS, when in fact their symptoms are caused by a different disease. Examples of diseases that can mimic MS include:

  • Infectious diseases like syphilis, Lyme disease, or HIV
  • Autoimmune diseases like systemic lupus erythematosus, sarcoidosis, or Sjogren's syndrome​
  • Vitamin B12 deficiency
  • Structural problem in the spine like a herniated disc
  • Genetic disorders like leukodystrophies
  • Brain or spinal cord tumor

Clues That Suggest You May Not Have MS

Most of the diseases that mimic MS have other clues that suggest an alternative diagnosis. For instance, while it's not unheard of, it's rare for a person to be diagnosed with MS over the age of 60 or before the age of 15. In addition, some mimicking conditions can be ruled out with blood tests, like vitamin B12 deficiency, syphilis, or HIV. Other conditions may require a biopsy (a tissue sample) like sarcoidosis.

Another clue is when neurological symptoms (numbness, tingling, weakness) are associated with significant back pain—a combination of symptoms that simply does not point to MS. Instead, the combination of neurological symptoms and back pain indicates more of a structural problem in the spine, like something that is compressing the spine—a herniated disc (common) or a spinal cord tumor (rare).

Of course, it still could be MS, or both (it does happen). The point here is that significant back pain with neurological symptoms is not typical in MS, and therefore warrants further investigation into an alternative diagnosis.

There are many other clues that point to a diagnosis other than MS and are specific towards that condition. For example, Lyme disease may mimic MS. That being said, one clue to differentiate the two is that Lyme disease usually affects the peripheral nervous system (nerves that travel from the spinal cord to the rest of your body) in addition to the central nervous system. MS affects only the central nervous system and not the peripheral nervous system. 

Clues That Suggest You May Have MS

Just as there are clues that suggest an alternative diagnosis, there are also clues that your symptoms are indeed from MS. For instance, if your symptoms occur at different intervals (at least one month apart) and within at least two different parts of the central nervous system (which consists of the brain, optic nerve, and spinal cord), this is consistent with a diagnosis of MS. 

Other clues include the worsening of neurological symptoms with heat (called Uthoff phenomenon ) and a disease course characterized by flares of neurological symptoms that either resolve completely or partially—called relapsing-remitting MS. This is the most common MS pattern, affecting 85 percent of patients. 

As part of the McDonald Criteria used to diagnose MS, your doctor will also likely order an MRI of your brain and/or spinal cord to assist in ruling in our ruling out multiple sclerosis. Other tests used to assist in the diagnosis or confirm a suspicion for MS include a lumbar puncture and/or visual evoked potentials

A Word From Verywell

It's important to remember that while there are a number of medical conditions that can mimic MS, for many people the diagnosis of MS is straightforward. In these situations, their symptoms are typical of MS, and the diagnosis is sort of a no-brainer requiring no additional tests. 

All in all, don't place the burden on yourself to diagnose your own health problems. See a doctor for a proper evaluation and testing.  If you are diagnosed with MS, that's OK too—the sooner, the better, so you can get started with therapy and move forward with your life. 

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Article Sources

  • Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. New York, New York. Oxford University Press. 
  • Gelfand, JM. (2014). Multiple Sclerosis: diagnosis differential diagnosis, and clinical presentation. Handbook of Clinical Neurology, 122:269-90.
  • Katz Sand, I.B., & Lublin, F.D. Diagnosis and differential diagnosis of multiple sclerosis. (2013). Continuum (Minneap Minn), Aug;19(4 Multiple Sclerosis):922-43.