MS and FMS -- which is it?

Discussion in 'Fibromyalgia Main Forum' started by marcus1243, Nov 8, 2002.

  1. marcus1243

    marcus1243 New Member

    Hi, everybody. I sincerely hope I'm not going to unduly worry, upset or offend anybody with this posting! It seems many of us are concerned about the possibility of MS, (myself included) with an alarming overlap of symptoms. I've done an awful lot of research on the subject and wrote up a little guide for my own reference, and I thought I might share it with you for your feedback and responses. I should stress at this point that I am NOT a doctor and have NO medical training -- I just read a lot (postings on MS forums sound so much like ours!)! Nobody should read this and try to self-diagnose, because medical professionals are trained to recognize theses disorders (though some of them don't seem to recognize fibro as a valid ilness yet!). I just thought that it would be handy to have an instant reference guide to compare the two illnesses. If I have made any mistakes, please reply with a correction and I'll make an amendment.
    All feedback welcome.
    Thanks,
    Marcus
    --------------------------------------------------------
    MULTIPLE SCLEROSIS & FIBROMYALGIA – A DIFFERENTIAL DIAGNOSIS

    Multiple Sclerosis is a progressive inflammatory disorder which destroys the myelin sheath around nerves, thus ‘short-circuiting’ the CNS, and relaying/receiving aberrant messages to and from the brain. Fibromyalgia on the other hand, is a dysfunctional neurotransmitter syndrome – ‘syndrome’ because it is supposedly non-progressive and non-inflammatory. Indeed, the yield of positive results from routine diagnostic testing with FMS patients is usually minimal, with occasionally some mechanical problems with the spine revealed on MRI, or occasionally concomitant disorders such as Candidiasis or Hypothyroidism revealed with blood work. Generally, the diagnosis – as with MS – is essentially clinical, which is to say that it is based upon presenting symptoms and medical history. And yet the symptoms of both MS and FMS are markedly similar, (especially in the early stages of MS), usually prompting MS screening tests for FMS sufferers. While only thorough diagnostic testing (Cervical and brain MRI, Sensory Evoked Potentials and Lumpar puncture) can aid towards a reliable diagnosis of MS, there appear to be some small but significant differences in clinical presentation of both entities which may aid in differentiating them. These differences are by no means definitive, but are merely suggestive of one disorder or the other. (It is of course entirely possible to suffer from both.)

    Paresthesiae/Numbness & Tingling
    While both MS and FMS patients will experience transient and migratory tingling and numbness in various parts of their bodies, the paresthesiae experienced in FMS sufferers tend to be found mostly in the extremities rather than in the torso, spine or trunk. A phenomenon known as ‘L’hermittes’ – a strong electrical shock sensation down the spine, elicited upon flexion of the neck – is suggestive of a disease process in the spinal cord. MS patients will experience periods of numbness consistent with the demyelination and remyelination of nerve tissue, which leaves the patient with a fixed numbness, lasting more than 24 hours. The numbness in FMS is likely more due to constricted blood supply and nerve impingement by fibrotic muscle tissue, and generally responds to therapeutic treatment (heat, massage etc). The numbness in MS does not typically respond to palliative treatment. Both MS and FMS patients may find that their limbs ‘go to sleep’ easily if subjected to pressure or long periods of inactivity. A ‘burning’ sensation upon the skin (typically on the skin of the legs and feet) is also common in both FMS and MS, and may respond to analgesic medications like Neurontin or low-dose antidepressants like Elavil (Amitriptyline).

    A phenomenon known as RLS (restless leg syndrome) is commonly found in FMS, whereby the patient experiences a buzzing, ‘humming’ sensation in the legs, and finds it imperative to periodically move them. It may worsen after exercise or over-activity. This is quite distinct from the shooting electric-shock like pains experienced due to insult to the CNS from a demyelinating process.

    Both MS and FMS sufferers can experience all of these paresthesiae on a daily basis.

    Medications
    FMS patients are notoriously intolerant of medications, and will suffer excessive side-effects from some NSAID’s (Non-steroidal anti-inflammatories like Ibuprofen), especially gastric disturbances. MS patients are generally more tolerant of painkillers and antidepressants. FMS, on the other hand, tends not to respond to corticosteroids, which are the drugs of choice to reduce or eliminate symptoms in flares or ‘exacerbations’ of MS (because FMS is believed to be a sensitization of the CNS rather than an inflammatory process). Many over-the-counter analgesics are of little effect in both disorders.


    Heat
    While both FMS and MS patients can be uncomfortable in hot and humid conditions, the effect of heat on many MS patients is quite disturbing, as it causes a reduction in the speed of nerve conduction, making pre-existing symptoms temporarily worse. A hot bath or shower can result in weakness, blurred vision, dizziness and nausea for an MS sufferer. FMS patients on the other hand, find that heat is a useful palliative tool for dealing with muscle pain, and many FMS patients feel at their most comfortable in a hot tub. This is a significant clinical difference between the two entities.


    Exercise
    While both MS and FMS patients might tolerate exercise well, rapid fatiguing of muscle with repetitive use of a certain muscle group might cause cramping, stiffness and pain in both. With MS, this is due to a nerve conduction fatiguability, and will commonly result in the affected limb/s failing to respond at all if the patient tries to continue. In FMS, the etiology is likely to be more metabolic in origin, and although the patient may keep on exercising, the muscles may become increasingly sore and fatigued. The FMS patient is more likely to notice that his muscles are particularly sore and tender after the exercise, a phenomenon due possibly to oxygen starvation or a glycogen storage abnormality. An FMS patient will not typically report that his legs ‘stopped working’, but rather that the exercise produces pain, fatigue and malaise. Exercise is often prescribed as a therapeutic tool in both illnesses, but can be particularly detrimental to FMS sufferers if a metabolic disorder is concomitant to the CNS sensitization. An FMS sufferer may experience pain and fatigue in the used muscles for several days after the actual event. MS patients, on the other hand, must be alert to the possibilities of exacerbation of existing symptoms due to exercise-induced heat.


    Weakness
    Weakness is one of the major clinical diagnostic criteria for MS, and a clinical diagnosis of the illness is unlikely in its absence. It might typically present unilaterally or bilaterally (with the former being slightly more common), and can be either subjective or objective and variable at different times of the day (though often worse in the late afternoon). Patients might report that one or both legs want to give way from beneath them, that they are stiff and ‘wooden-feeling’ and uncoordinated. Sudden leg weakness might result in an MS patient falling, or a ‘foot-drop’ effect cause them to drag an ankle or leg. With FMS, weakness of the extremities is less common, and is due more due to a combination of trigger points within muscle groups and abnormal muscle fatigue. The combination of antagonistic muscle action and fatigue can produce sensations of weakness and incoordination in the legs that are usually accompanied by a degree of pain. While some muscle spasticity might be experienced (and consequently a painful ‘tightening’ of joints), reflexes are usually found to be normal on clinical examination. The FMS sufferer will report ‘buckling knees’ rather than a sudden onset of weakness that might precipitate a fall. The muscles in FMS sufferers seem also to undergo a ‘jelling’ phenomena, leading them to stiffen over periods of disuse (eg. sitting for long periods or after a night’s sleep), and can be unresponsive for a period upon ‘re-activation’; this sensation can be reported by the patient as weakness and incoordination; it usually resolves upon re-use of the muscle group in question. This particular manifestation is not a common finding in MS.


    Bladder & Bowel
    Bladder problems can arise in both illnesses, but there are significant differences. In MS, the problem is usually one of a neurogenic bladder, which arises from the interruption of nerve signals to and from the bladder. This can result in urge incontinence, urinary retention, or hesitancy. The patient commonly does not realize how full the bladder is, and may be caught short by an urgent need to void. With FMS, interstitial cystitis – a feeling of an uncomfortable or tender bladder – tends to be the cause of frequent urination. Urge incontinence is generally experienced less with these patients, who might also experience bladder sensitivity/over activity due to the irritation of smooth muscle. There also seems to be a greater incidence of UTI’s (urinary tract infections) in FMS patients than with MS.

    In MS patients, constipation is the most frequently reported complaint. In FMS, sufferers will find that diarrhea and constipation may alternate, with diarrhea being more common. This aberrant bowel behavior is known as IBS (Irritable Bowel Syndrome), and is again thought to be caused by irritation and spasm of smooth muscle rather than having neurological origins.


    Balance
    While both MS and FMS patients will complain of feeling dizzy or ‘light-headed’, the FMS patient does not usually present with true ataxia, but rather from a disequilibrium, arising from altered visual perception and compounded by trigger points within the musculature of the neck. The MS patient on the other hand will typically lose their balance on the Romberg test and when asked to perform tandem gait ambulation, the balance problems here arising from neurologic insult to the brainstem.


    Vision
    Optic/retrobulbar neuritis is a common presenting symptom of MS, and is indicative of an inflammatory process. The symptoms are sharp pain behind the eyes, blurring, hazed or double vision, and/or a shift in the perception of colors. Visual field defects might also be experienced. In FMS, eye pain, frontal headaches and ocular migraines are more prevalent, and visual effects relating to these – such as flashing lights – are common. FMS sufferers will also report blurred vision, though this is of a transitory nature and will typically fluctuate during the day according to the state of fatigue. This phenomenon is due to fatiguing of the muscles that control focusing, and may be impacted by the presence of ocular ‘trigger points’ which make eye movement more uncomfortable. Unlike optic neuritis, this symptom is not exacerbated by heat. Floaters, photophobia and problems with glare and flare are reported by both MS and FMS patients, though this complaint is more common with FMS sufferers. The etiology is unknown.


    Muscle Symptoms
    Both FMS and MS patients widely complain of muscle pains, cramps, spasms, fasciculations, and tremors. It can be hard to differentiate between neurological and metabolic causality with these phenomena, but again, there are subtle differences: In MS, the primary cause of muscle pain is spasticity, which is the involuntary contraction of extensor or flexor muscle groups, causing the limb in question to become rigid. This can be accompanied by painful cramping as the stressed muscle exhausts its oxygen supply. This phenomenon is not as widely found in FMS; rather a milder spasticity arising from trigger points and over-fatigued muscle is likely to be found, where the spasms are less violent and traumatic. These can appear anywhere in the body, appearing sometimes as abdominal pains or sometimes even as throat discomfort.

    Cramps are common to both, and are typically found more in MS patients at rest, (being neurological in origin), whereas FMS patients may experience them more frequently during exercise. Fasciculations (muscle twitching) are extremely common in FMS (despite established diagnostic criteria making little mention of them), but are not, on the other hand, part of the clinical picture of MS.

    Tremors can be experienced by patients of both illnesses, and may come and go; sometimes these might be experienced as internal or invisible tremors. In MS, the more common tremor is of the intentional variety, and is provoked by the patient reaching out to touch or hold an object. With FMS, the tremor is induced by muscle fatigue and is usually observed as a very fine ‘essential’ tremor (at rest), which presents bilaterally. Again it is possible to have both.


    Fatigue
    With MS, fatigue can be experienced as a body-wide ‘heaviness’ or as an overwhelming, almost narcoleptic ‘shutdown’, where the patient simply cannot continue to function without a period of rest or sleep. While fatigue is very common in FMS, it is not usually as incapacitating as the ‘central fatigue’ of MS, and is more commonly attributable to sleep disturbances and the strain of having to deal with so much pain on a day-to-day basis.


    It might be seen therefore, that based on the above symptoms, enough subtle differences exist that an experienced clinician should be able to differentiate between what are two very similar disorders, though of course, diagnostic testing will always provide the cornerstone of a reliable diagnosis.
  2. marcus1243

    marcus1243 New Member

    Hi, everybody. I sincerely hope I'm not going to unduly worry, upset or offend anybody with this posting! It seems many of us are concerned about the possibility of MS, (myself included) with an alarming overlap of symptoms. I've done an awful lot of research on the subject and wrote up a little guide for my own reference, and I thought I might share it with you for your feedback and responses. I should stress at this point that I am NOT a doctor and have NO medical training -- I just read a lot (postings on MS forums sound so much like ours!)! Nobody should read this and try to self-diagnose, because medical professionals are trained to recognize theses disorders (though some of them don't seem to recognize fibro as a valid ilness yet!). I just thought that it would be handy to have an instant reference guide to compare the two illnesses. If I have made any mistakes, please reply with a correction and I'll make an amendment.
    All feedback welcome.
    Thanks,
    Marcus
    --------------------------------------------------------
    MULTIPLE SCLEROSIS & FIBROMYALGIA – A DIFFERENTIAL DIAGNOSIS

    Multiple Sclerosis is a progressive inflammatory disorder which destroys the myelin sheath around nerves, thus ‘short-circuiting’ the CNS, and relaying/receiving aberrant messages to and from the brain. Fibromyalgia on the other hand, is a dysfunctional neurotransmitter syndrome – ‘syndrome’ because it is supposedly non-progressive and non-inflammatory. Indeed, the yield of positive results from routine diagnostic testing with FMS patients is usually minimal, with occasionally some mechanical problems with the spine revealed on MRI, or occasionally concomitant disorders such as Candidiasis or Hypothyroidism revealed with blood work. Generally, the diagnosis – as with MS – is essentially clinical, which is to say that it is based upon presenting symptoms and medical history. And yet the symptoms of both MS and FMS are markedly similar, (especially in the early stages of MS), usually prompting MS screening tests for FMS sufferers. While only thorough diagnostic testing (Cervical and brain MRI, Sensory Evoked Potentials and Lumpar puncture) can aid towards a reliable diagnosis of MS, there appear to be some small but significant differences in clinical presentation of both entities which may aid in differentiating them. These differences are by no means definitive, but are merely suggestive of one disorder or the other. (It is of course entirely possible to suffer from both.)

    Paresthesiae/Numbness & Tingling
    While both MS and FMS patients will experience transient and migratory tingling and numbness in various parts of their bodies, the paresthesiae experienced in FMS sufferers tend to be found mostly in the extremities rather than in the torso, spine or trunk. A phenomenon known as ‘L’hermittes’ – a strong electrical shock sensation down the spine, elicited upon flexion of the neck – is suggestive of a disease process in the spinal cord. MS patients will experience periods of numbness consistent with the demyelination and remyelination of nerve tissue, which leaves the patient with a fixed numbness, lasting more than 24 hours. The numbness in FMS is likely more due to constricted blood supply and nerve impingement by fibrotic muscle tissue, and generally responds to therapeutic treatment (heat, massage etc). The numbness in MS does not typically respond to palliative treatment. Both MS and FMS patients may find that their limbs ‘go to sleep’ easily if subjected to pressure or long periods of inactivity. A ‘burning’ sensation upon the skin (typically on the skin of the legs and feet) is also common in both FMS and MS, and may respond to analgesic medications like Neurontin or low-dose antidepressants like Elavil (Amitriptyline).

    A phenomenon known as RLS (restless leg syndrome) is commonly found in FMS, whereby the patient experiences a buzzing, ‘humming’ sensation in the legs, and finds it imperative to periodically move them. It may worsen after exercise or over-activity. This is quite distinct from the shooting electric-shock like pains experienced due to insult to the CNS from a demyelinating process.

    Both MS and FMS sufferers can experience all of these paresthesiae on a daily basis.

    Medications
    FMS patients are notoriously intolerant of medications, and will suffer excessive side-effects from some NSAID’s (Non-steroidal anti-inflammatories like Ibuprofen), especially gastric disturbances. MS patients are generally more tolerant of painkillers and antidepressants. FMS, on the other hand, tends not to respond to corticosteroids, which are the drugs of choice to reduce or eliminate symptoms in flares or ‘exacerbations’ of MS (because FMS is believed to be a sensitization of the CNS rather than an inflammatory process). Many over-the-counter analgesics are of little effect in both disorders.


    Heat
    While both FMS and MS patients can be uncomfortable in hot and humid conditions, the effect of heat on many MS patients is quite disturbing, as it causes a reduction in the speed of nerve conduction, making pre-existing symptoms temporarily worse. A hot bath or shower can result in weakness, blurred vision, dizziness and nausea for an MS sufferer. FMS patients on the other hand, find that heat is a useful palliative tool for dealing with muscle pain, and many FMS patients feel at their most comfortable in a hot tub. This is a significant clinical difference between the two entities.


    Exercise
    While both MS and FMS patients might tolerate exercise well, rapid fatiguing of muscle with repetitive use of a certain muscle group might cause cramping, stiffness and pain in both. With MS, this is due to a nerve conduction fatiguability, and will commonly result in the affected limb/s failing to respond at all if the patient tries to continue. In FMS, the etiology is likely to be more metabolic in origin, and although the patient may keep on exercising, the muscles may become increasingly sore and fatigued. The FMS patient is more likely to notice that his muscles are particularly sore and tender after the exercise, a phenomenon due possibly to oxygen starvation or a glycogen storage abnormality. An FMS patient will not typically report that his legs ‘stopped working’, but rather that the exercise produces pain, fatigue and malaise. Exercise is often prescribed as a therapeutic tool in both illnesses, but can be particularly detrimental to FMS sufferers if a metabolic disorder is concomitant to the CNS sensitization. An FMS sufferer may experience pain and fatigue in the used muscles for several days after the actual event. MS patients, on the other hand, must be alert to the possibilities of exacerbation of existing symptoms due to exercise-induced heat.


    Weakness
    Weakness is one of the major clinical diagnostic criteria for MS, and a clinical diagnosis of the illness is unlikely in its absence. It might typically present unilaterally or bilaterally (with the former being slightly more common), and can be either subjective or objective and variable at different times of the day (though often worse in the late afternoon). Patients might report that one or both legs want to give way from beneath them, that they are stiff and ‘wooden-feeling’ and uncoordinated. Sudden leg weakness might result in an MS patient falling, or a ‘foot-drop’ effect cause them to drag an ankle or leg. With FMS, weakness of the extremities is less common, and is due more due to a combination of trigger points within muscle groups and abnormal muscle fatigue. The combination of antagonistic muscle action and fatigue can produce sensations of weakness and incoordination in the legs that are usually accompanied by a degree of pain. While some muscle spasticity might be experienced (and consequently a painful ‘tightening’ of joints), reflexes are usually found to be normal on clinical examination. The FMS sufferer will report ‘buckling knees’ rather than a sudden onset of weakness that might precipitate a fall. The muscles in FMS sufferers seem also to undergo a ‘jelling’ phenomena, leading them to stiffen over periods of disuse (eg. sitting for long periods or after a night’s sleep), and can be unresponsive for a period upon ‘re-activation’; this sensation can be reported by the patient as weakness and incoordination; it usually resolves upon re-use of the muscle group in question. This particular manifestation is not a common finding in MS.


    Bladder & Bowel
    Bladder problems can arise in both illnesses, but there are significant differences. In MS, the problem is usually one of a neurogenic bladder, which arises from the interruption of nerve signals to and from the bladder. This can result in urge incontinence, urinary retention, or hesitancy. The patient commonly does not realize how full the bladder is, and may be caught short by an urgent need to void. With FMS, interstitial cystitis – a feeling of an uncomfortable or tender bladder – tends to be the cause of frequent urination. Urge incontinence is generally experienced less with these patients, who might also experience bladder sensitivity/over activity due to the irritation of smooth muscle. There also seems to be a greater incidence of UTI’s (urinary tract infections) in FMS patients than with MS.

    In MS patients, constipation is the most frequently reported complaint. In FMS, sufferers will find that diarrhea and constipation may alternate, with diarrhea being more common. This aberrant bowel behavior is known as IBS (Irritable Bowel Syndrome), and is again thought to be caused by irritation and spasm of smooth muscle rather than having neurological origins.


    Balance
    While both MS and FMS patients will complain of feeling dizzy or ‘light-headed’, the FMS patient does not usually present with true ataxia, but rather from a disequilibrium, arising from altered visual perception and compounded by trigger points within the musculature of the neck. The MS patient on the other hand will typically lose their balance on the Romberg test and when asked to perform tandem gait ambulation, the balance problems here arising from neurologic insult to the brainstem.


    Vision
    Optic/retrobulbar neuritis is a common presenting symptom of MS, and is indicative of an inflammatory process. The symptoms are sharp pain behind the eyes, blurring, hazed or double vision, and/or a shift in the perception of colors. Visual field defects might also be experienced. In FMS, eye pain, frontal headaches and ocular migraines are more prevalent, and visual effects relating to these – such as flashing lights – are common. FMS sufferers will also report blurred vision, though this is of a transitory nature and will typically fluctuate during the day according to the state of fatigue. This phenomenon is due to fatiguing of the muscles that control focusing, and may be impacted by the presence of ocular ‘trigger points’ which make eye movement more uncomfortable. Unlike optic neuritis, this symptom is not exacerbated by heat. Floaters, photophobia and problems with glare and flare are reported by both MS and FMS patients, though this complaint is more common with FMS sufferers. The etiology is unknown.


    Muscle Symptoms
    Both FMS and MS patients widely complain of muscle pains, cramps, spasms, fasciculations, and tremors. It can be hard to differentiate between neurological and metabolic causality with these phenomena, but again, there are subtle differences: In MS, the primary cause of muscle pain is spasticity, which is the involuntary contraction of extensor or flexor muscle groups, causing the limb in question to become rigid. This can be accompanied by painful cramping as the stressed muscle exhausts its oxygen supply. This phenomenon is not as widely found in FMS; rather a milder spasticity arising from trigger points and over-fatigued muscle is likely to be found, where the spasms are less violent and traumatic. These can appear anywhere in the body, appearing sometimes as abdominal pains or sometimes even as throat discomfort.

    Cramps are common to both, and are typically found more in MS patients at rest, (being neurological in origin), whereas FMS patients may experience them more frequently during exercise. Fasciculations (muscle twitching) are extremely common in FMS (despite established diagnostic criteria making little mention of them), but are not, on the other hand, part of the clinical picture of MS.

    Tremors can be experienced by patients of both illnesses, and may come and go; sometimes these might be experienced as internal or invisible tremors. In MS, the more common tremor is of the intentional variety, and is provoked by the patient reaching out to touch or hold an object. With FMS, the tremor is induced by muscle fatigue and is usually observed as a very fine ‘essential’ tremor (at rest), which presents bilaterally. Again it is possible to have both.


    Fatigue
    With MS, fatigue can be experienced as a body-wide ‘heaviness’ or as an overwhelming, almost narcoleptic ‘shutdown’, where the patient simply cannot continue to function without a period of rest or sleep. While fatigue is very common in FMS, it is not usually as incapacitating as the ‘central fatigue’ of MS, and is more commonly attributable to sleep disturbances and the strain of having to deal with so much pain on a day-to-day basis.


    It might be seen therefore, that based on the above symptoms, enough subtle differences exist that an experienced clinician should be able to differentiate between what are two very similar disorders, though of course, diagnostic testing will always provide the cornerstone of a reliable diagnosis.
  3. pam_d

    pam_d New Member

    Thanks for providing this very good comparison of the symptom similarities & differences between FM & MS, very easy to read. I think many of us here have gone through the MS "wondering" & testing phase, and some still aren't sure, so this is good info!

    Pam
  4. klutzo

    klutzo New Member

    I went through MS testing when I got FMS, after being mid-diagnosed with it for 4 yrs. Back then MRI had not been invented. I wish I had seen this article then. The only MS symptom I have is that I do have an abnormal Romberg, probably due to brain damage. I have no balance when in the dark, for example.
    Thanks for an informative post.
    KLutzo
  5. tedebear

    tedebear New Member

    Nice breakdown and comparison. Thanks. Soft hugs.
  6. granmama

    granmama New Member

    I want to say how very much I appreciated the article you posted.
    My son is suspected to have MS and I do have FM.
    I am printing this and mailing it to him. He knows I suffer with chronic pain and I know that his symptoms are similar to mine, but as your article points out...different!

    I believe he will be appreciative of the article as well.

    thanks again,
    granmama
  7. lease79

    lease79 New Member

    I have cfs/fms & have been screened for MS, as I was really worried that I had it :(
    I read up BIG time before I got checked out, it looks like you've done your homework too ;)
    My Mother & my Grandmother have all been screened for it too. My Grandmother has rhumetoid athritis & my mother has spinal/neck injury & suspicion of FMS.
    I have all the visual symptoms of ms, double vision, a problem focusing on red & green, shadows, extreme photo sensitivity etc...
    I was really worried, but my neuro check came back normal & my MRI results were normal in that respect, (they showed non specific increase of water content along the visual tracts.)
    Thanks again, it was a good read!

    Lease
  8. moma

    moma New Member

    how do I print this report? all I get is blank pages!
  9. Shirl

    Shirl New Member

    You can do what I do to print something from the board.
    I cut and past it in an email to myself. Then I print it out from the email.
    It also takes less paper/ink as the print is smaller!

    Hope this helps.

    Shalom, Shirl
  10. kadywill

    kadywill New Member

    Thank you so much for the hard work you put into this. It is very informative and easy to read.
    Love,
    Kady
  11. dhcpolwnk

    dhcpolwnk New Member

    While I greatly admire and respect the work you have done in trying to compare and contrast MS and FMS, Marcus, I want to urge those who suspect they might have MS to get a solid diagnosis. I was diagnosed with MS in 1978 (probably had it in 1967, though) and was only recently diagnosed with FMS. I certainly don't pretend to know all there is about MS, but I do know that some of the things mentioned in your post don't seem to apply to me.

    Paresthesiae/Numbness & Tingling
    While both MS and FMS patients will experience transient and migratory tingling and numbness in various parts of their bodies, the paresthesiae experienced in FMS sufferers tend to be found mostly in the extremities rather than in the torso, spine or trunk. A phenomenon known as ‘L’hermittes’ – a strong electrical shock sensation down the spine, elicited upon flexion of the neck – is suggestive of a disease process in the spinal cord. MS patients will experience periods of numbness consistent with the demyelination and remyelination of nerve tissue, which leaves the patient with a fixed numbness, lasting more than 24 hours. The numbness in FMS is likely more due to constricted blood supply and nerve impingement by fibrotic muscle tissue, and generally responds to therapeutic treatment (heat, massage etc). The numbness in MS does not typically respond to palliative treatment. Both MS and FMS patients may find that their limbs ‘go to sleep’ easily if subjected to pressure or long periods of inactivity. A ‘burning’ sensation upon the skin (typically on the skin of the legs and feet) is also common in both FMS and MS, and may respond to analgesic medications like Neurontin or low-dose antidepressants like Elavil (Amitriptyline).

    For example, you say that weakness is one of the major clinical diagnostic criteria for MS, and a clinical diagnosis of the illness is unlikely in its absence. That really hasn't been my experience, though my most recent neurological exam did show muscle weakness. (And there is *no* doubt about my diagnosis. My last two MRIs have show extensive "white matter disease" consistent with an MS diagnosis, and my clinical history reveals the typical exacerbating/remitting pattern over a period of many years, until recently, when my MS became secondary progressive, though still with occasional relapses.

    I'm not trying to worry people with FMS, but just as they have told those of us with MS for years, just because you have multiple sclerosis, it doesn't mean you can't have something else wrong, too. The important thing is that if there is a treatment for that something else, you need to get the diagnosis right. And although MS isn't curable, there are several treatments that have been shown to have a positive impact on the disaease process and on long-term accumulation of disability.

    MS diagnoses still aren't perfect, but they're a lot easier now than when I first was diagnosed (pre-MRI). Please realize that it is perfectly possible to lead a full and productive life even if you do have MS, especially if it is properly treated, and if you can get the health services and items you need.

    I only just started on Avonex (one of the MS drugs I mentioned above) five weeks ago. It wasn't available when my MS was still in the exacerbating/remitting form, when it is believed to be most effective. These drugs may not be right for everybody, even for everybody who has R/R MS, but if you or your doctor suspects possible MS, I urge you *not* to let fear keep you from checking it out.

    --Laura R.M.
  12. marcus1243

    marcus1243 New Member

    With everything you say. The guide is only that, and I wrote it simply to lay down some broad guidelines for people who were looking for some diagnostic criteria. Multiple Sclerosis is an insidious illness that can present with almost any symptoms, and only when it reaches a more advanced stage does it more clearly present itself for what it is. And because FM has sometimes led to other autoimmune conditions (Sjogrens, Rheumatoid Arthritis etc), Fibro sufferers should be aware of the possibilities, unlikely though they may be.

    There is a classic form of MS that presents itself in a readily recognizable way (Optic neuritis + footdrop for example), but there are many Fibro sufferers (including myself) who experience leg weakness, blurred vision, bladder problems and paresthesiae, who are left wondering where one illness stops and the next begins. I agree absolutely that everyone who has doubts should be tested. What I *am* saying though is that hardly anybody on this board will find themselves diagnosed with MS, simply because there are now strict guidelines for official diagnosis, (based on number of lesions etc), and a quick visit to an MS board will confirm that there are very many people stuck in 'limboland', awaiting an official diagnosis.

    By the way, Laura, may I add that I visited your website and am full of admiration and respect for the way that that you have taken on these challenges and helped to advise and inspire others. There is absolutely no greater courage in my opinion.
    Best wishes,
    Marcus
  13. allhart

    allhart New Member

    you did a very good job ,i just went threw my 2nd round of testing in 4 years for ms and everything of course turned out fine after reading this i can see why the dr was so baffled because even after reading your brake down some of my symtoms are more like ms like feeling as though your legs not there and falling,when im going threw the leg numbness i cant feel the needle on my legs and also my left arm is always numb,
    i also have a big promblem with my gait
    the neurologist says hes sure its not ms and that the fm shouldnt alone cause such sever promblem he did say a combation of something like fm and lupus or fm and ra can

    so even if you are still worried about ms it could be a combation of your illnesses togeter causeing the promblems

    thank you so much marcus this was realy grate,
    [This Message was Edited on 12/01/2002]
  14. marcus1243

    marcus1243 New Member

    And I'm so glad that your MS tests were negative. But your doctor is right -- FMS rarely seems to exist in isolation as time goes on, and a combination of autoimmune conditions can certainly present with some apparent neurological signs such as gait ataxia (due to muscle fatigue and weakness -- the brain tends to try and compensate for it over time).

    To be honest, with the symptoms you describe, lesions would be readily apparent on MRI, and if you don't have them, you certainly *don't* have MS. Nor are you likely now to get it.
    I hope others read your post and take comfort from the fact you are still very much a Fibro patient rather than an MS one, even with those symptoms.

    I hope you manage to find some improvement in your health. (I take it you've been tested for Lyme?)
    Best wishes,
    Marcus
  15. dhcpolwnk

    dhcpolwnk New Member

    Thanks for the nice comment about my web site, Marcus. I invite anyone who may be interested to visit. Since we're not supposed to post URLs on this board, just enter "Laura Remson Mitchell" (without the quotation marks in most search engines), and when the search results come up, click on the site titled "LRM's Place." (I think Yahoo's search engine just calls my site "Laura Remson Mitchell's home page," or some such thing.) If you have trouble finding it, just e-mail me at af752@lafn.org and I'll send you the link.

    --Laura R.M.


    [This Message was Edited on 12/03/2002]

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