Common Misdiagnosis: Multiple Sclerosis
One of the most common answers to the question was multiple sclerosis . Both diagnoses have an effect on the central nervous system. These diagnoses also frequently cause muscle spasms, balance changes, tremor, and impaired memory. However, these are two separate diagnoses.
One difference is that MS is often diagnosed when someone is in their 20s, while most people receive a PD diagnosis in their 60s. Also, MS is an autoimmune disease that over time causes nerve damage. Parkinsons affects the brain. The brain starts producing less and less dopamine, which is responsible for controlling movement.
Yes, with MS which I was worried about for years, but right now I do not know which one is worse. However, my meds are helping a lot. My new saying is It is what it is, aka just live on. My neurologist says that I have stage one mild Parkinson’s disease.
My husband was diagnosed with MS back in 1993 when he had a mini stroke. He was diagnosed with Parkinsons in 2014.
Diagnosis Of Depression In Parkinsons Disease
Diagnosing depression in PD can be particularly difficult because of the clinical overlap between the two syndromes.
Symptoms that are common to both depression and idiopathic Parkinsons disease include motor slowing, bradyphrenia, sleep and appetite disturbance, weight loss, loss of interest and concentration, and reduced libido. The body language of depression looks similar to that of PD at first glance. The patient often appears hunched with a lack of an obvious affective response and spontaneity .
Symptoms that may help in the diagnosis of depression in people with PD include;
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pervasive low mood with diurnal variation
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early morning wakening
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pessimistic thoughts about the world, themselves, and the future
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suicidal ideation.
Table 1 lists the Diagnostic and statistical manual, 4th revision criteria for major depressive episode.
Table 1
DSM-IV criteria for major depressive episode
Depression should be considered in any patient whose function deteriorates notably over a few days or weeks.
Table 2
Differential diagnosis of depression in Parkinsons disease
A variety of mood disorders have been described in the setting of neurosurgery for PD. These include transient dysphoria during surgery . More chronic changes in mood have also been described following pallidotomy and deep brain stimulation although definitive studies have not been performed in this area.
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Knowing That It Is Msa And Not Parkinsons Is Important
Over the years MSA Coalition Board Members have heard the frustration about a slow diagnosis after the initial diagnosis of Parkinsons.While MSA is fatal, knowing the correct diagnosis, is still important.
Multiple system atrophy affects multiple systems in the body.As a result, while there are not MSA specific treatments, treating the various symptoms from sleep disorders, urinary and bowel issues, blood pressure control, etc. can vastly improve quality of life. The earlier an MSA patient is diagnosed, the earlier doctors can establish a plan of action to improve symptoms that can be very disabling. Another factor is that Parkinsons medications typically stop working in MSA patients.
An early diagnosis also allows patients and their families to spend quality time together while they are still able.It also provides time to prepare for end-of-life issues, such as preparing wills and living wills.
How Are They Alike
MS and Parkinsonâs both affect your central nervous system, which includes your brain and spinal cord. Thatâs why they both can affect how you move, sleep, feel, and talk.
These diseases both affect your nerves. MS can break down the coating, called myelin, that surrounds and protects your nerves. In Parkinsonâs, nerve cells in a part of your brain slowly die off.
Both can start out with mild symptoms, but they get worse over time.
Common symptoms of both diseases include:
- Shaky fingers, hands, lips, or limbs
- Slurred speech thatâs hard for others to understand
- Numb or weak limbs that make your walk unsteady
- Loss of muscle control that often affects one side of your body at first, then later both
- Spastic limb movements that are hard to control
- Loss of bladder or bowel control
- Poor balance
Depression is another symptom common to both conditions.
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Is It Possible To Have Ms And Parkinsons Disease
Unfortunately, yes it is possible to have co-existing MS and Parkinsons disease. Given their similarities, you would think that they are too similar for them to co-exist together. They both affect the CNS, they are degenerative neurologic conditions, and it just wouldnt be fair.;
However, MS is an autoimmune disease. Parkinsons is not. Given this fact alone, it is entirely possible for them to co-exist.
In 2015, a team of researchers set out to determine if co-existing MS and Parkinsons disease was coincidental or were a cause-effect situation meaning, in this particular study, did the presence of Parkinsons increase the likelihood of developing MS?
The researchers studied 8947 MS cases with 44735 control cases. According to the study, Our results suggest a causal effect of MS on PD in MS – whether this can be explained by the localization of lesions alone is not clear.
What Doctors Look For When Diagnosing Parkinsons
Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:
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Shaking or;tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving
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Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
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Rigidity: Stiffness in the arms, legs or;trunk
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Posture instability: Trouble with balance and possible falls
Once the patient is at the doctors office, the physician:
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Takes a medical history and does a physical examination.
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Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
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Performs a neurological examination, testing agility, muscle tone, gait and balance.
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Multiple Sclerosis Vs Parkinsons Disease: Us Prevalence And Economic Impact
Anyone can develop multiple sclerosis, but it mostly affects 20- to 40-year-olds. Prevalence of multiple sclerosis in the U.S. is estimated at over 400,000 cases, and nearly 200 new cases are diagnosed each week. Rates of multiple sclerosis are highest in areas furthest away from the equator, so the rates are higher in the Northern U.S.
Direct and indirect costs resulting from multiple sclerosis can range from $8,528 to $54,244.
One million Americans live with Parkinsons disease. The average cost of Parkinsons disease including treatment, lost work wages, and social security payments is $25 billion annually in the U.S.
Symptoms Of Depression In Ms
Like Parkinsons disease, vegetative or somatic symptoms do not tend to be good diagnostic discriminators for depression in MS. Some vegetative symptoms may be specifically related to fatigue rather than depression, but this area is fraught with methodological and conceptual difficulties. One study has indicated that disinterest in sex was uniquely related to depression in MS . Important clues to depression in MS are illustrated in table 4.
Important clues to depression in multiple sclerosis
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Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
Is There A Link
Some people have MS and Parkinsonâs, but it could be a coincidence.
Research suggests that the damage that MS causes to your brain can lead some people to develop Parkinsonâs later on.
If you have MS, your immune system triggers ongoing inflammation. This can create lesions in your brain that cause Parkinsonâs disease. If lesions form in certain spots in your brain, they can affect how it makes dopamine.
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A New Blood Test That Might Help With Diagnosis
Researchers recently discovered a blood test that can detect a specific protein found in the blood of Parkinsons patients but not MSA patients. The protein, known as alpha-synuclein, is produced in nerve cells in the brain and can be detected in the blood. It is one of the proteins that accumulate and damages the brains of people with both MSA and Parkinsons. However, the protein collects in different cells in the brain, depending on which disease it is.7
Common Symptoms Of Parkinsons Disease
Symptoms generally develop slowly over years, and the progression of symptoms is often different from one person to another due to the diversity of the disease. According to The Parkinsons Foundation, there are three telltale symptoms that can help doctors make a diagnosis:
- Bradykinesia
- Tremors
- Rigidity
Bradykinesia, or slowness of movement, coupled with tremor or rigidity must be present for a PD diagnosis to be considered. Prior to experiencing motor symptoms, stiffness and tremor, often people will complain of sleep problems, constipation, decreased ability to smell and restless legs.
Postural instability often accompanies motor symptoms and can lead to imbalance and falls common among Parkinsons patients. Additional movement symptoms can include:
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Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
Diagnosis Of Depression Post
A number of factors can make the diagnosis of depression difficult post-CVA. Communication difficulties, impairments of facial and emotional expression, and disturbance in vegetative functions can make assessment of mental state extremely difficult. A deterioration in function over a few days or weeks following a period of improvement is one clinical clue for the development of depression.
Extreme abulia can sometimes be mistaken for depression and can be related to either frontal and diencephalic lesions. The patient may appear to be extremely retarded but may function at a high level within a structured environment. Dopamine agonists, such as bromocriptine, have been used to treat abulia.
Pathological emotionalism is relatively common after stroke, affecting up to 20% of patients in the first six months post-stroke but tending to improve over the following year. Severe examples of pathological emotionalism have been treated with antidepressant medication and levodopa.
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So What Is It Is It Parkinsons Disease Or Is It Something Else
The answer is not easy, but many who feel they have more than Parkinsons may in fact have multiple system atrophy .MSA is a very rare disorder that has similarities and features of Parkinsonism.However, it is so rare that many physicians are unfamiliar with it and so the diagnosis is not considered. As a result, a likely diagnosis of MSA might be delayed by years and even missed all together. Whats more, due to many symptoms that could possibly be attributed to other conditions diagnosing MSA can be challenging, even to the most experienced doctors. This can be very frustrating to those who know it is more than PD.
How Do You Diagnose These Diseases
Both diseases can be difficult to diagnose, and they require a neurology workup and medical history. You might have some brain imaging or blood tests to rule out other causes for your symptoms.
For MSA, doctors will test your autonomic functions, like how well you produce sweat and how well your body maintains a stable blood pressure when you stand up after sitting or lying down.5 Parkinsons doesnt have a specific test for diagnosis. Sometimes doctors will prescribe anti-Parkinsons medication and diagnose Parkinsons if it helps improve your symptoms.1
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What Is Parkinsons Disease
Parkinsons disease is a neurodegenerative disorder that affects predominately dopamine-producing neurons in a specific area of the brain called substantia nigra. Dopamine is a neurotransmitter that is primarily responsible for controlling movement, emotional responses and the ability to feel pleasure and pain.
The cells that make dopamine are impaired and as the disease progresses, the more dopamine-producing brain cells die. Once a person develops motor symptoms, the amount of dopamine loss is already substantial. The brain eventually reaches a point where it stops producing dopamine in any significant amount, thus increasing problems with movement.
Scales Used To Measure Depression In Parkinsons Disease
As mentioned above, symptoms of idiopathic PD have considerable overlap with those of depression. This means that standard rating scales for depression may not be valid in this situation. Rating scales for depression may be loaded with somatic or vegetative symptoms, which reduce their validity.
Three rating scales have been tested using a clinical interview with operationalised diagnosis as a gold standard. Using receiver operating curves, the sensitivity and specificity at a given cut off point can be calculated. From this methodology, it is clear that the Beck depression inventory is not a useful rating scale in PD. The Montgomery and Asberg depression rating scale and the Hamilton depression scale have performed better. In summary, diagnosis of depression should be made clinically, using appropriate diagnostic criteria, with severity or response to treatment being measured using MADRS or HAM-D.
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Benefits Of Inpatient Rehabilitation
Inpatient rehabilitation hospitals are required to provide an interdisciplinary approach to patient caremeaning specialists from many disciplines are involved in creating and implementing a patients care plan. Interdisciplinary team members include physical, speech and occupational therapists, rehabilitation physicians, nurses, case managers, dietitians and pharmacists. Patients participate in three hours of therapy each day for a total of 15 hours per week, and an individualized plan of care is created for each patient to meet their needs while providing necessary intervention to make functional gains. Inpatient rehabilitation can be beneficial for both MS and Parkinsons disease.
Educational sessions with the patient and family members can also improve understanding for all involved in the patients care about the progression of each disease and ways to combat symptoms.
Bethany Moss is a physical therapist at Encompass Health Rehabilitation Hospital of Jonesboro. She is a PWR! certified therapist and a LVST BIG certified clinician.
Multiple Sclerosis Vs Parkinsons Disease: Treatment And Therapies
Treatment for multiple sclerosis is lifelong, and although it cannot cure the condition, it aims to minimize symptoms and allow the patients to live as normal of a life as possible. Some treatment methods include corticosteroids and plasma exchange, beta interferons, Glatiramer acetate, Dimethyl fumarate, Fingolimod, Teriflunomide, Natalizumab, Alemtuzumab, and Mitoxantrone, which all help to reduce the likelihood of relapses.
Other treatment methods include physical therapy to improve mobility, muscle relaxants, medications to reduce fatigue, and other medications like antidepressants, medications to control the bowels and bladder, and medications to improve sexual function.
Exercise, meditation, yoga, and acupuncture are also recommended as a means to reduce stress and improve overall mental and physical well-being.
There is no cure for Parkinsons disease as well, but treatments are available to manage the symptoms and slow down the disease progression as much as possible. Alongside traditional treatments, supportive therapies are also used to improve different aspects of a persons health.
Common medications prescribed in Parkinsons disease include dopamine replacement therapy, dopamine agonists, anticholinergics, amantadine, monomine oxidase type B inhibitors, and catechol-o-methyl transferase inhibitors.
You can work closely with your doctor to create a specific treatment plan for you.
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Myasthenia Gravis And Multiple Sclerosis: Differences And Similarities
Multiple sclerosis presents patients with a number of symptoms that can disrupt everyday life. During an episode for those with relapsing-remitting MS, or those with one of the progressive MS forms with constant symptoms, obtaining a diagnosis that allows the patient to work with doctors and therapists to create a treatment and management regimen is crucial to living a full and healthy life.
Of course, MS is not the only chronic disease that causes such issues or requires direct attention. Another condition, called Myasthenia gravis, can also cause significant impairment when trying to complete daily activities. In fact, Myasthenia gravis actually seems quite similar to some aspects of multiple sclerosis and distinguishing one from the other is essential to prescribing the right treatment plan.
Multiple Sclerosis Vs Parkinsons Disease: Risk Factors And Complications
Risk factors for multiple sclerosis include being female, having a;family history of multiple sclerosis, having certain infections,;being white of European descent, living furthest from the equator, living in temperate climate regions, already having an autoimmune disease, and;smoking.
Complications resulting from multiple sclerosis include muscle stiffness and spasms, paralysis, problems with bladder, bowel, and sexual function, as well as forgetfulness, mood changes, depression, and epilepsy.
Risk factors for Parkinsons disease include being over the age of 50, being male, having a family history of Parkinsons disease, carrying gene variations, experiencing a head injury, being exposed to environmental toxins, and taking certain medications such as anti-anxiety medications or sleeping pills.
Complications associated with Parkinsons disease include difficulty thinking, depression, emotional changes, swallowing problems, sleep problems and disorders, bladder issues, constipation, changes in blood pressure, smell dysfunction, fatigue, pain, and sexual dysfunction.
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