Differences Between Peripheral Neuropathy and MS

Though some symptoms overlap, these are distinct conditions

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Peripheral neuropathy and multiple sclerosis (MS) are neurological disorders that share several symptoms, including pain and paresthesias (abnormal sensations). Either condition can make it difficult to use your arms and hands or to walk. Despite these similarities, peripheral neuropathy and MS are completely distinct diseases with different causes and treatments.

Both of these can worsen if they are not medically managed, so it is important to seek medical attention if you experience neurological symptoms. While you may be diagnosed with one of these concerns, it's possible to also have the other or an entirely different neurological issue as well.

Symptoms

There are some symptoms that the two conditions share, but patterns and timing differ. In addition, MS produces a wider range of symptoms than peripheral neuropathy does.

Those That Overlap

Both MS and peripheral neuropathy can cause tingling, pain, or decreased sensation of the hands, arms, feet, or legs. The tingling and other sensory problems of MS tend to affect one side of the body, while they generally affect both sides in peripheral neuropathy in what is described as a "stocking-glove" pattern.

MS is more likely than peripheral neuropathy to cause muscle weakness, but some types of peripheral neuropathy can make you weak as well.

MS is also much more likely than peripheral neuropathy to cause bowel and bladder control problems and sexual difficulties, as well as visual problems, slurred speech, and trouble swallowing.

Cognitive (thinking and problem solving) difficulties are only seen in MS patients.

Timing and Pattern

Most patients with MS will develop weakness and numbness as a part of a flare-up, therefore, symptoms usually develop within a couple of days and persist for a few weeks, tending to improve afterward, especially if you seek medical help and start treatment right away.

On the contrary, the majority of the neuropathies are chronic, meaning symptoms develop slowly over time and tend to initially affect the feet, followed by lower legs and subsequently the hands.

Causes

Peripheral neuropathy and MS affect different areas of the nervous system.

  • MS affects the brain, spinal cord, and optic nerves, which are areas of the central nervous system.
  • Peripheral neuropathy affects the peripheral nervous system, which includes sensory and motor peripheral nerves located throughout the body in areas such as the arms and legs.

MS is believed to occur when the body's own immune system attacks the myelin (a fatty protective layer that coats nerves) in the central nervous system. This interferes with the nerves' ability to function properly, resulting in the symptoms of MS. Genetics and environmental factors are believed to contribute to this inflammatory autoimmune demyelination.

A number of conditions can damage the peripheral nerves and lead to peripheral neuropathy. Common causes include:

Some peripheral neuropathies (mononeuropathies) affect only one nerve, whereas others (polyneuropathies) affect multiple nerves. Furthermore, different neuropathies either result from damage to the axons (nerve fibers) or the myelin.

Diagnosis

Your physical examination is likely to be very different when it comes to peripheral neuropathy and MS. For example, reflexes are decreased or absent in peripheral neuropathy, whereas they are brisk with MS. And MS can cause spasticity or stiffness of the muscles, while peripheral neuropathy does not.

Also, with peripheral neuropathy, your sensory deficit is almost always worse distally (farther away from your body) than proximally (closer to your body), while this pattern is not present in MS.

Despite those differences, diagnostic tests are often performed to confirm what is causing your symptoms as well as the extent and severity of your illness.

Diagnostic Tests

Blood work can be helpful in identifying many of the causes of peripheral neuropathy, but blood tests are usually normal in MS. However, blood tests can identify illnesses that may mimic MS, such as another autoimmune condition or an infection.

Nerve tests like electromyography (EMG) and/or nerve conduction velocity (NCV) studies are expected to show signs of peripheral neuropathy, but they are not associated with any abnormalities in MS.

Magnetic resonance imaging (MRI) and lumbar puncture typically show signs of MS, but usually, they don't show significant changes in patients with peripheral neuropathy.

Treatment

Treatment of the underlying disease process differs for MS and peripheral neuropathy, but symptomatic treatment is often the same.

For example, treatment of painful paresthesias in MS and peripheral neuropathy can include:

  • Nonsteroidal anti-inflammatories (NSAIDs)
  • Certain antidepressants like Elavil (amitriptyline) or Cymbalta (duloxetine)
  • Certain anticonvulsants like Lyrica (pregabalin) or Neurontin (gabapentin)
  • Topical medications like topical lidocaine or capsaicin

Besides medication, other pain-alleviating therapies used in both illnesses include:

There are no effective treatments for sensory loss. Occupational therapy and physical therapy may be of some benefit in terms of adjusting to the loss of sensation in both MS and peripheral neuropathy.

Treatment of the diseases themselves is not the same. There are a number of MS disease disease-modifying treatments (DMTs) used to prevent progression and MS exacerbations (flare-ups). Exacerbations are typically treated with intravenous (IV) steroids.

Peripheral neuropathy is treated based on the underlying cause. For example, if diabetes is the culprit, then getting your blood sugar under control is a primary goal. If a medication or toxin is causing the side effect, removing or stopping the offending agent is important.

In general, management of peripheral neuropathy is focused on preventing additional nerve damage, as there is no medication for repairing a nerve. In some situations, surgery for peripheral neuropathies in which a single nerve is compressed (for example, carpal tunnel syndrome) can be effective.

And plasmapheresis, which is plasma exchange, can be an option for severe cases of MS or some forms of peripheral neuropathy. With this procedure, blood is removed from the body and filtered through a machine so that harmful substances can be removed before the blood is returned to the body.

A Word From Verywell

Although you may be tempted to delay seeing your doctor, nervous system symptoms should not be ignored. While you're waiting for your appointment, it's helpful to keep a log of your symptoms so you can describe them in detail. Include any patterns in their occurrence and aggravating or provoking factors.

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