Multiple sclerosis and chronic fatigue syndrome/myalgic encephalomyelitis have much more in common than most people realize. The symptoms can be staggeringly similar – fatigue, muscle weakness, pain, urinary frequency, cognitive problems and neurological symptoms.
Both illnesses primarily affect women, but can strike anyone, including children. Both can be progressive, even deadly. Both have been connected to some viral infections, including herpesviruses and enteroviruses, and even some bacteria, like Chlamydia pneumoniae.
CFS/ME is thought to affect about 0.5% of people, while MS has a prevalence of about 0.1% (though it varies widely between countries, mostly by latitude). Thus CFS/ME is more common, yet poorly known by doctors compared to MS.
"It is extremely common for MS patients to have symptoms which may sound bizarre to an inexperienced physician, because they fail to conform to anatomical boundaries or physiological concepts, they may be extremely transient, lasting for no more than minutes or seconds, and most importantly cannot be confirmed by objective findings." (Charles M. Poser, author of the Poser criteria for the diagnosis of multiple sclerosis.)
This, of course, goes for CFS/ME as well, as many patients have unfortunately learned.
Diagnostic Tests for CFS/ME and MS
There are currently no proper diagnostic tests or biomarkers in use for either CFS/ME or multiple sclerosis (some tests are being studied, however). Contrary to common belief, brain MRI cannot tell CFS/ME and MS apart. Brain lesions in MRI are seen in up to 50% of CFS/ME cases.
Even the lumbar puncture (spinal tap) tests in clinical use cannot tell these two apart. Both CFS/ME and multiple sclerosis (and other illnesses) may feature oligoclonal bands in the CSF. Neither are visual evoked potentials (VEPs) diagnostic. However, peripheral nerve and muscle damage is almost unheard of in MS, but may often be demonstrated in CFS/ME.
Some blood test results are typical of CFS/ME, including a low ESR (as low as 0), though a small fraction of patients have elevated ESR. CFS/ME patients often display significant immune dysfunction; especially, IgG1 and IgG3 subclass deficiencies and impaired NK cell function are very common, though these immune tests are only rarely run.
XMRV, CFS/ME and MS
XMRV is a recently discovered retrovirus which was found in the majority of CFS/ME patients in a much publicized study published in the journal Science in 2009. Later, several studies have been unable to find such an association, while multiple other study groups have been able to replicate the results.
Some CFS/ME activists are now treating XMRV testing as more or less a diagnostic test for CFS/ME, but this is highly controversial. Not only do not all CFS/ME patients have XMRV, but it is unclear whether MS patients may have it. Preliminary findings of XMRV in "atypical multiple sclerosis" have been reported. A small percentage of healthy people also harbor XMRV.
Difference in Symptoms
Currently the only method of differential diagnosis of MS and CFS/ME is by looking at the symptoms. While all other kinds of neurological symptoms are common to both, optic neuritis (inflammation of the optic nerve) is typical of MS but unusual in CFS/ME (many other vision disturbances, however, are normal in CFS/ME). Paresthesias (abnormal sensations) are often associated with both, but tend to be more migratory (moving around) in CFS/ME.
Severe post-exertional malaise is unique to CFS/ME. Both physical and mental exertion tend to worsen fatigue, weakness, pain, fever and neurological symptoms. Some sufferers describe the symptoms as flu-like, others feel "poisoned". The malaise can be delayed by more than 24 hours and recovery can take days, weeks or even months.
CFS/ME usually also has non-neurological symptoms, especially allergic and immune symptoms (like fever and swollen lymph nodes), though not all patients have them. Gastrointestinal, pulmonary and skin symptoms are common. Many have heart problems, often diagnosable heart damage such as mitral valve prolapse or myocarditis.
Heat intolerance is a part of both CFS/ME and MS, but tends to be more severe in MS. In CFS/ME the person usually feels sick or fatigued from heat, but an MS patient can develop even neurological symptoms not previously seen. CFS/ME patients often tolerate cold as poorly as heat and tend to be highly sensitive to medications, as well.
Multiple sclerosis typically features relapses or attacks. The course of CFS/ME can vary widely, with exacerbations of illness often called "crashes". Infections and stress can cause relapses in both, but CFS/ME crashes are most typically the result of exertion.
Does the Diagnosis Matter?
CFS/ME and multiple sclerosis are mostly treated by different medications. The interferons used in MS treatment have been used in CFS/ME too, but this is not a standard therapy. Interestingly, the best treatment for both MS and CFS/ME appears to be the immunomodulator low dose naltrexone. Antiherpesvirus drugs are another effective treatment for CFS/ME, occasionally also used in MS.
Ironically, for many people with CFS/ME getting an incorrect diagnosis of MS can actually be beneficial, as the latter is better recognized and accepted by the society, including both doctors, laymen and social security/insurance companies – and many CFS/ME patients get no proper treatment anyway.
Whether CFS/ME and MS can coexist is controversial and there is no clear consensus.
References
- Poser, Charles M. The Differential Diagnosis Between Mulltiple Sclerosis and Chronic Fatigue Postviral Syndrome. In the book: Hyde B, (ed.) The Clinical and Scientific Basis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. The Nightingale Research Foundation 1992.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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