Multiple Sclerosis can defy logic in its presentation. Alternating complaints of numbness, weakness and dizziness can confuse a host of health providers not to mention the patient suffering through an array of difficulties.
At the same time, MS can be quite orderly with a series of monthly very specific neurologic complaints such as numbness in a limb one month followed by weakness and numbness in the same limb the next month followed by incoordination in that arm or leg for a few weeks.
Medical illness in general can be episodic or progressive. It can include a variability of signs and symptoms within the context of one disease. However, the variability of presentations in MS is legendary. In fact, what often is a bizarre collection of signs and symptoms is a tip off to the clinician that MS is in the house.
MS can present like so called Complicated Migraine, with specific neurologic complaints of an episodic nature. Such problems, including hemiplegia, can come and go just like Migraine and be associated with headache. In the vast majority of Migraine patients however, while there may be episodes of neurologic dysfunction, there are neither permanent deficits nor progression of neurologic disability reflecting permanent brain injury. Such potential permanence is the risk in MS when hot plaques can eventually lead to white greater than gray matter irreversible brain or spinal cord damage.
MS can also behave like a degenerative neurologic disease where there can be progressive loss of function of one or more limbs over many months (the feared progressive form of MS as opposed to the more common relapsing and remitting variant). Again, there are many disorders of the nervous system such as Parkinson disease, Lou Gehrig disease (ALS) and Alzheimer disease that lead to patient deterioration over time. MS is more classically punctuated by “attacks” as opposed to these other conditions which reveal a more insidious decline.
Many autoimmune diseases, like MS, can show this “attack” tendency. Systemic Lupus Erythematosus (SLE) is classic in this regard and can be confused with MS. However, unlike diseases such as SLE than can affect multiple organs such as the nervous system, the heart and the kidneys, MS is confined to the central nervous system. Why such autoimmune disease, like MS, characteristically afflicts young women is unknown.
Psychiatric disease is a wide ranging topic but often in the background for so many medical illnesses, particularly those inducing depression. Pancreatic cancer and hypothyroidism for example can present with the patient showing such a mood disorder. MS is frequently associated with depression and this can be related to strategic plaques in the brain or due to immunomodulator therapy. Psychosis can be seen in Lupus or in any patient on corticosteroids. Obviously, such a behavioral condition can occur in MS patients who are often on corticosteroids but who can reveal an “organic psychosis” due to brain plaques signaling disease activity.