Multiple Sclerosis: Hit or MisdiagnosisSlippery symptoms and inconclusive tests make reliable screening a challenge
For two years, Angela's* doctor advised her to overcome her chronic bouts of fatigue and weakness by eating a healthier diet, losing weight, and reducing her stress levels. Although Angela followed her doctor's advice, bouts of fatigue and weakness continued to plague her.
Even after Angela started experiencing balance problems, her doctor took a wait-and-see approach before finally ordering an MRI several months later. The eventual diagnosis: multiple sclerosis (MS).
Access the MS Information page from the National Institute of Neurological Disorders and Stroke.
Seven years later, Angela is doing well. She has been able to control her condition with medications that calm her symptoms. However, she often wonders how much damage was done to her body in the years she spent waiting for the correct diagnosis. She wonders how much better off she might be today if her disease had been diagnosed when she first reported problems.
Blurred or double vision, weakness in the limbs, feelings of numbness and tingling, difficulty concentrating, problems with memory, fatigue, and clumsiness all are symptoms that could indicate MS. However, not only is MS characterized by a wide variety of symptoms, but it also shows up differently from person to person, making accurate and early diagnosis difficult.
Furthermore, there is no single symptom or test that positively establishes MS in all cases, so missed diagnoses, where the condition is present but not diagnosed, are common.
In fact, a person could live with the disease for years without knowing it, as in Angela's case. In a recent study of 50 people with MS, 58% of the patients were initially given 41 wrong diagnoses before being properly diagnosed with MS. On average, the patients weren't correctly diagnosed until 3 1/2 years after the onset of symptoms. MS affects between 250,000 and 350,000 people in the United States. It most often occurs in people who are in their 20s to mid-40s.
What is MS?
Multiple sclerosis is an autoimmune disease of the nervous system. The cause of MS is still unknown. For reasons not completely understood, the body's own immune cells begin to attack myelin -- a fatty substance that insulates the nerves of the brain and spinal cord. Nerve cells themselves also may be damaged by these attacks.
The result can be a host of different neurological symptoms, in addition to those mentioned above. A person suffering from MS might also experience pain, speech disturbances, paralysis, and emotional highs and lows. It is a chronic and often relapsing condition.
Getting an Accurate Diagnosis
If you suspect you may have MS, it is important to begin tracking your symptoms as soon as you start to experience them, and then make an appointment to discuss your symptoms with your doctor. Many people with MS find that their symptoms come and go, whereas others have a gradual worsening of their symptoms.
Your doctor will use the symptom information you supply, as well as results from any diagnostic tests performed, such as magnetic resonance imaging (MRI), to support or rule out a diagnosis of MS.
The symptom information you provide and your test results may also help to rule out or diagnose other similar conditions for which MS is often confused. Chronic fatigue syndrome, encephalomyelitis, lupus erythematosus, Lyme disease, syphilis, color blindness, and vitamin B12 deficiency are just a handful of the conditions that could be mistaken for MS.
Misdiagnosis of MS, when the condition is diagnosed but not present, is also common. In a study, 5%–10% of patients were told they had MS when the disease was not actually present.
Although any doctor can diagnose MS, neurologists are health professionals who specialize in the diagnosis and treatment of nerve-related diseases such as MS.
Approximate Prevalence of Symptoms
- Weakness of the limbs: 40%–50%
- Sensory loss: 40%–45%
- Visual loss: 16%–36%
- Gait disturbance: 5%–15%
- Double vision: 7%–15%
- Dizziness/Vertigo: 5%
- Pain: 3%
-- Source: Merck Medicus Best Practice Report Multiple Sclerosis
Damage May Happen Early
Much has been accomplished in the field of MS research in the last 10 years. The advent of the MRI made it possible for researchers to get a better grasp of how the disease operates and progresses. As a result, scientists have learned that even when MS patients are not experiencing symptoms, the disease may still be active and cause silent damage to the nervous system. Because of this, accurate and early diagnosis may be critical in preventing permanent damage to nerve cells.
With accurate and early diagnosis, patients will be able to benefit fully from the tremendous treatment advances that medical science has made in the past decade. Although in Angela's case diagnosis came late, she is currently benefiting from the latest science has to offer. Not all cases of MS can be controlled completely; however, with appropriate treatment, a long and active life is well within the realm of possibility for many people.
*Angela is a fictionalized case study example.