Multiple sclerosis (MS) is an immune-mediated inflammatory condition that shares symptoms with many other conditions. Shared symptoms can mean doctors misdiagnose some people.
A conclusive diagnosis involves ruling out other conditions and checking for signs and symptoms that are specific to MS. Healthcare professionals refer to this process as a “differential diagnosis.”
This article describes what MS is, including its symptoms, causes, and treatment. It also investigates how common it is for doctors to misdiagnose MS, lists some conditions with similar symptoms, and explores protocols doctors use to draw a differential diagnosis.
MS is an immune-mediated inflammatory condition in which the immune system mistakenly attacks the myelin sheath that protects and insulates the nerves of the brain and spinal cord. This disrupts communication between the brain and other parts of the body.
According to the
- vision problems, such as:
- tingling, numbness, or pain in the face, torso, or limbs
- muscle weakness in the hands and legs, sometimes with painful spasms
- difficulties with balance and coordination
- difficulty controlling the bladder
- dizziness that may be intermittent or constant
- cognitive difficulties and mental fatigue
- mood changes, such as depression
The results of a 2019 study suggest that
The study investigated 241 evaluations from people at two separate clinics in the U.S. It found that up to 19% of people diagnosed with MS did not fulfill the McDonald criteria, which doctors use to diagnose MS.
The researchers concluded that these people likely had conditions with symptoms similar to those of MS. The most common misdiagnoses were:
- migraine (16%)
- radiologically isolated syndrome (9%)
- spondylopathy (7%)
- neuropathy (7%)
According to another
- incorrectly applying the McDonald criteria during diagnosis
- diagnosing conditions solely on the results of an MRI scan without investigating the presence or lack of other symptoms
- being reluctant to change a past diagnosis of MS despite evidence suggesting a different condition
Here are some conditions that doctors are more likely to misdiagnose as MS.
Migraine is a complex neurological condition. It causes moderate to severe throbbing headache episodes, typically on one side of the head. Other symptoms of migraine can include:
- feeling dizzy and unbalanced
- increased sensitivity to light and sound
- visual disturbances, such as blurred vision or flashing lights
- numbness in the hand that moves up the arm and into the face
- mental fog
Experts do not know the exact cause of migraine. However, temporary changes to chemicals, nerves, and blood vessels inside the brain likely play a role.
Although there is no cure for migraine, treatments can help to reduce the frequency and severity of headache episodes. Possible treatment options include:
- over-the-counter pain relievers such as acetaminophen and ibuprofen
- triptans, which are prescription pain medications that work by constricting dilated blood vessels around the brain
- antinausea or motion sickness medications
2. Radiologically isolated syndrome (RIS)
RIS is a neurological condition characterized by changes or lesions in the brain or spinal cord.
RIS can often indicate MS because the lesions appear very similar to the lesions MS causes. However, a person will not yet have any other symptoms that characterize MS.
Often, a doctor will discover a person has RIS from looking at imaging of the brain done for other reasons, such as trauma to the head or unexplained dizziness. More than half of people with RIS go on to develop MS within
There is currently no cure for RIS. The treatment
In some high risk cases, a doctor may prescribe medications for MS before the person actually develops the disease. In other cases, a doctor may choose to observe the person for signs that MS is developing while prescribing medication to treat the person’s present non-MS symptoms.
3. Cervical spondylosis
This condition can naturally occur with age, typically affecting people
The following medications can help to manage the condition and alleviate symptoms:
There are also exercises a person can do to relieve symptoms.
Neuropathy is the medical term for nerve damage or dysfunction. Causes include:
- physical damage to the nerves resulting from injury or surgery
- certain infections, such as:
- certain underlying health conditions, such as:
- exposure to certain toxins, such as:
The symptoms of neuropathy depend on the type a person has. Possible symptoms include:
- numbness and tingling in the limbs and extremities
- reduced sensitivity to touch and temperature
- increased sensitivity to stimuli, resulting in unexpected pain
- problems with coordination and balance
- muscle weakness or paralysis
- constipation or diarrhea
- rapid heart rate
- excessive sweating
The treatment for neuropathy depends on the underlying cause and the symptoms a person experiences. Treatment options include:
- medications for neuropathic pain, such as:
- capsaicin cream to treat skin pain or discomfort
- medications to treat specific symptoms
5. Cerebral small vessel disease (CSVD)
Although multiple factors can cause CSVD, the
Symptoms and complications of CSVD include:
The treatment for CSVD focuses on medications that relax the small blood vessels, improve blood flow, and decrease blood pressure.
Fibromyalgia is a chronic condition characterized by pain throughout the body. Though it is not entirely clear what causes fibromyalgia, certain factors such as genetics, stress, and changes in the function of the central nervous system may contribute.
Fibromyalgia and MS share several similar symptoms, including headaches, fatigue, and numbness or tingling of the extremities. Other symptoms of fibromyalgia include:
- feeling too hot or too cold
- difficulty learning new things or remembering information
- extreme sensitivity
Treatment often includes a combination of physical activity and talk therapy, which can help improve quality of life and ease symptoms. Doctors may recommend certain medications, including antidepressants, and alternative treatments, such as acupuncture.
7. Vitamin B12 deficiency
Certain medical conditions or dietary changes can cause a vitamin B12 deficiency. Older adults (ages 65 years and over), vegans and vegetarians, people who have undergone bariatric surgery, and those taking certain medications may also be at an
Symptoms of vitamin B12 deficiency may include:
- difficulty walking
- pain or tingling in the extremities
- uncontrollable muscle movements
- unintentional weight loss
- changes in the sense of smell or taste
- vision problems
- cognitive impairment or dementia
Depending on the severity and cause of the deficiency, treatment may include oral supplements or injections.
8. Acute disseminated encephalomyelitis (ADEM)
ADEM is a condition that causes a brief, widespread period of inflammation in the brain and spinal cord. This can damage the myelin (protective layer surrounding the nerves).
This condition often occurs after viral or bacterial infection and is
Symptoms of ADEM may include:
- vision loss in one or both eyes
- difficulty with movement or coordination
- weakness, sometimes to the point of paralysis
Treatment typically involves the use of corticosteroids to suppress inflammation. Doctors may recommend additional treatment methods to help manage symptoms.
9. Conversion disorder
Conversion disorder, also known as a functional neurological disorder, occurs when a person experiences physical or sensory problems without a physical explanation. A
Because symptoms typically appear after a period of emotional or physical distress, some experts believe that a reaction to stress or neurological changes may cause conversion disorder.
Possible symptoms of conversion disorder include:
While it is unclear exactly why some people develop sarcoidosis, some experts believe environmental factors may trigger the condition in people who are more susceptible due to their genes.
Symptoms of sarcoidosis depend on the affected organs. They may include:
- shortness of breath
- persistent dry cough
- tender bumps on the skin
- swollen glands in the neck, face, armpit, or groin
- joint pain
- nasal congestion
Most cases of sarcoidosis do not require treatment, as the condition typically resolves on its own over time. However, in some cases, a doctor may recommend lifestyle changes to manage flare-ups, and certain medications, including steroids.
11. Copper deficiency
Copper is an important mineral involved in energy production, iron metabolism, and brain development. Though it is found naturally in various food sources, some groups may have an
Symptoms of copper deficiency include:
- bone weakness
- loss of skin pigment
- impaired coordination
- high cholesterol level
- decreased immune function
Generally, treatment involves addressing any underlying conditions that affect copper absorption. A person may also need to make changes to their diet to help prevent deficiency.
Lupus is a chronic condition that occurs when the immune system attacks its own tissues, causing inflammation, joint and muscle pain, skin rash, and fatigue.
It is unclear what causes lupus. However, the following factors may contribute to or cause flare-ups of the condition:
- certain types of medications
- viral infection
- sun exposure
- hormones such as estrogen
Doctors typically treat lupus with medications, including anti-inflammatory drugs and steroid tablets. Diet and lifestyle changes can also help manage symptoms and slow the progression of lupus.
13. Neuromyelitis optica spectrum disorder (NMOSD)
NMOSD, also known as Devic disease, is a condition that causes inflammation of the optic nerve and spinal cord.
Experts believe people with a family history of autoimmune disorders may have a greater risk of developing NMOSD.
Symptoms of NMOSD include:
- pain inside the eye
- loss of clear vision
- pain in the limbs or spine
- partial or full paralysis of the lower limbs
- loss of bladder control or bowel control
Doctors may prescribe several medications to treat NMOSD, including immunosuppressant drugs and corticosteroids. They may also prescribe anticonvulsants and antispastics to manage symptoms and help prevent long-term complications.
14. Lyme disease
One of the first symptoms is typically a rash. It occurs in around
Other symptoms of Lyme disease include:
- muscle and joint aches
- nerve pain
- numbness or tingling in the hands or feet
A doctor may prescribe medications such as steroids to reduce inflammation and help prevent complications.
According to the National Multiple Sclerosis Society (NMSS), many other diseases and conditions can cause symptoms similar to those of MS. Examples include:
According to the NMSS, a doctor will confirm MS by ruling out other diseases and disorders that may have similar symptoms, as well as checking for signs and symptoms specific to MS. A doctor will also:
- ask about a person’s medical history
- ask about family history
- perform a neurological exam
A doctor may then request the following tests:
- blood tests to check for certain diseases or deficiencies
- a lumbar puncture to analyze spinal fluid for antibody abnormalities associated with MS
- an MRI scan to look for lesions on the brain and spinal cord
- evoked potential tests, which measure how quickly information passes through nerve pathways
Despite advances in MS research, there is no single test for the condition. As such, diagnosis is not always a straightforward process.
Below are a few common questions about the diagnosis of MS.
What can doctors mistake for MS?
Many conditions share similar symptoms with MS, which can increase the risk of misdiagnosis. According to one
How common is MS misdiagnosis?
Doctors can misdiagnose MS. In fact, one study estimates that up to one-fifth of people with MS may be living with a misdiagnosis.
Can doctors misdiagnose MS on MRI?
Misinterpretation of MRI results can be a common cause of misdiagnosis of MS. One study found that only
Some conditions that doctors may commonly misdiagnose as MS include migraine, RIS, spondylopathy, and neuropathy.
To accurately diagnose MS, doctors must rule out conditions with similar symptoms and look for signs and symptoms specific to MS. As such, the process of diagnosing MS may be lengthy and complex. Nonetheless, an accurate diagnosis is essential to determine the most appropriate course of treatment.