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Medical Edge Newspaper Column from Mayo Clinic
DOES MY ELDERLY MOM REALLY HAVE MS?
DEAR MAYO CLINIC: My mother, age 67, was recently referred to a neurologist because her family doctor thinks she has multiple sclerosis. But personally, I suspect that my mother is being prescribed too many medications — she takes a dozen of them — and the combination could be simulating MS symptoms (as well as creating other problems). From all I’ve heard and read, MS is usually diagnosed prior to age 50. Please advise. — Indianapolis
ANSWER: Drugs do not generally cause MS, though there have been some rare exceptions. Certain drugs used for rheumatoid arthritis or Crohn’s disease — for example, etanercept (Enbrel) and infliximab (Remicade) — have produced the symptoms and findings of MS. And the combination of 5-fluorouracil and levamisole, sometimes used for treating colon cancer, has shown a similar tendency.
In some cases, certain drugs produce symptoms of MS even though the patient does not have MS. For example, any anticholinergic drug used to treat bladder irritability or drugs to treat depression (e.g., amitriptyline) can cause visual blurring and urinary retention. And pain medications such as narcotics, tricyclic antidepressants and anti-anxiety medications may cause fatigue. But in my experience, medication side effects — even from multiple drugs — do not usually produce a picture that is highly suggestive of MS.
Other diseases also can mimic MS. Infections, inflammation of the central nervous system, genetic conditions and structural abnormalities of the spinal cord (a herniated disc, for example) can produce symptoms that are distinctly MS-like. So can a deficiency of vitamin B12.
MS is an autoimmune disease, which means that the immune system attacks part of the body as if it is foreign. In MS in particular, the body inappropriately directs antibodies and white blood cells against proteins in the myelin sheath, an insulating layer that surrounds the nerves of the brain and spinal cord. These attacks cause inflammation and injury to the myelin sheath and ultimately to the nerves themselves, producing multiple areas of scarring (sclerosis). Eventually, these scars slow or block the nerve signals that control muscle coordination, strength, sensation and vision, resulting in a chronic and potentially debilitating condition.
MS causes diverse neurological symptoms, such as partial or complete vision loss, double vision, vertigo, weakness, numbness, fatigue, muscle stiffness or spasticity, and bladder or bowel dysfunction. It may come on in the form of sudden flare-ups (relapsing/remitting MS) or as a gradual decline (progressive MS). Although the disease can occur at any age, most people experience their first symptoms between the ages of 20 and 40; while relatively uncommon, MS can begin after the age of 50. Twice as many patients are women.
MS can be difficult to diagnose — not only because its symptoms are similar to those of other conditions, but also because its manifestations can vary considerably across patients. The neurologist to whom your mother has been referred will perform a careful evaluation before concluding that she has MS.
The process will likely include a medical history, neurological examination, magnetic resonance imaging scan (which can reveal MS lesions caused by myelin loss), and possibly a spinal tap to look for MS-associated abnormalities in the cerebrospinal fluid and evoked potential tests to measure the transmission of electrical signals within the brain and spinal cord.
— Brian G. Weinshenker, M.D., Neurology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment of MS
Appointment Information
More Information on MS
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© 2005 TRIBUNE MEDIA SERVICES, INC.
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