18 Sep 2002 

Multiple Sclerosis compared with ME

By  Dr Anne Macintyre

Both MS and ME are neurological conditions, and the similarities cause confusion with
diagnosis - especially if there are neurological symptoms or signs with ME/CFS.
People who have ME may be diagnosed as MS by neurologists who do not believe or
recognise ME. Some people initially diagnosed with ME may in fact have early MS, and
the diagnosis of MS then becomes apparent as time goes on.

Similarities

Sex: Apparent predominance of females.
Age: Peak age of onset is 20-40.
Fatigue (central) and weakness are prominent symptoms in both.
Both MS and ME may have a variety of neurological symptoms and sensory changes.
Both can be precipitated by a virus or an immunisation.
Emotional lability is a common feature of both.
Abnormalities of MRI scans, VEP (visual evoked potentials) and CSF (cerebrospinal
fluid) may be found in both illnesses. Both are diagnosed on clinical grounds (there
is no 100% test for MS), with frequently normal investigations. Both ME and MS tend
to follow a relapsing and remitting pattern, and become chronic, without shortening
life expectancy (with a few exceptions in both).

Differences

ME tends to occur in outbreaks or clusters as well as sporadic cases, pointing to an
effective onset. Clusters of MS are not seen. ME has myalgias and arthralgias (pain
in muscles and joints) and stricking muscle weakness after minimal exercise, the
weakness affecting muscles that were used. MS symptoms must be disseminated in time
and space for diagnosis. MRI abnormalities are mainly periventricular in MS, but
sub-cortical in ME (if present). Sensory changes are usually: in MS - numbness,
prickly and fixed. In ME - burning and migratory. Certain autonomic dysfunctions seen
in ME are not seen in MS e.g. gut, cardiovascular system, hormones.

Neurological symptoms of MS

Diploplia (double vision)
Nystagmus (jerky eye movements)
Ophthalomoplegia (weakness or paralysis of extra ocular muscles)
Clonus, extensor platar responses, true ataxia.
Brainstem signs, sphincter dysfunction.
Absent abdominal reflexes.
Dysarthria (slurred speech)

MS tends to involve the brain and spinal cord, and affects cranial nerve nuclei, but
not peripheral nerves.

ME tends to have neurological symptoms that are NOT backed up by objective signs on
examination.

MS does not have fevers, sore throats and tender glands.

ME does not have the sensitivity to hot weather and baths seen in MS.

Summary of main differences

"Despite the clinical and laboratory similarities between the two, the following
features of CFPVS (chronic fatigue post viral syndrome - another name for ME) would
tend to suggest that it is not the same as MS: The dendency of CFPVS (ME) to occur in
epidemic, no such event having been convincingly demonstrated in MS, the stricking
involvement of muscle, the characteristic myalgias and arthralgias, and the plethora
of systemic manifestations"       Charles M Poser MD

The above information is from the book "The Clinical and Scientific Basis of ME (CFS)
BM Hyde et al 1992. Chapter 42 "The differenctial diagnosis between MS and Chronic
Fatigue Post Viral Syndrome" by Dr Charles Poser