- Amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are neurodegenerative diseases that impact the central nervous system.
- People with MS and ALS may face memory problems and cognitive impairment.
- People with MS often experience greater mental impairment than people with ALS. People with ALS typically develop greater physical difficulties.
Amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are neurodegenerative diseases that affect the central nervous system. Both attack the body’s nerves and muscles. In many ways, these two diseases are similar. However, key differences determine a lot about treatment and outlook:
|affects brain and central nervous system||affects brain and spinal cord|
|late stage often leaves people paralyzed||late stage can affect mobility, but rarely leaves people completely debilitated|
|more physical difficulties||more mental impairment|
|not an autoimmune disease||an autoimmune disease|
|more common in men||more common in women|
|most commonly diagnosed in people between ages 40-70||most commonly diagnosed in people between ages 20-50|
|no known cure||no known cure|
|often debilitating and ultimately fatal||rarely debilitating or fatal|
What is ALS?
ALS, also known as Lou Gehrig’s disease, is progressive and fatal. ALS greatly affects the brain and central nervous system. In a healthy body, motor neurons in the brain send signals throughout the body, telling muscles and body systems how to work. ALS slowly destroys those neurons, preventing them from working correctly.
Eventually, ALS destroys the neurons completely. When this happens, the brain can no longer give commands to the body, and individuals with late-stage ALS become paralyzed.
What is MS?
MS is a central nervous system disorder that affects the brain and spinal cord. It destroys the protective coating on nerves. This slows the relay of instructions from the brain to the body, making motor functions difficult.
MS is rarely completely debilitating or fatal. Some people with MS will experience mild symptoms for many years of their lives but never become incapacitated because of it. However, others may experience a rapid progression of symptoms and quickly be unable to care for themselves.
Both diseases attack and destroy the body, affecting muscle and nerve function. For that reason, they share many of the same symptoms, especially in early stages. Initial symptoms include:
- muscle weakness and stiffness
- loss of coordination and muscle control
- difficulty moving limbs
However, the symptoms then become quite different. People with MS often experience greater mental impairment than people with ALS. People with ALS typically develop greater physical difficulties.
|Symptoms of ALS||Symptoms of MS|
|involuntary muscle spasms||✓||✓|
|numbness or tingling of face, body, or extremities||✓|
|tendency to trip or fall||✓|
|hand weakness or clumsiness||✓|
|difficulty holding your head up or maintaining good posture||✓|
|dizziness or vertigo||✓|
|slurred speech or difficulty swallowing||✓||✓|
|emotional changes, such as depression or mood swings||✓|
ALS commonly starts in the hands, feet, or arms and legs, and affects muscles that a person can control. This includes muscles in the throat, and it can also affect vocal pitch when speaking. It then spreads to other parts of the body. It has a gradual onset that’s painless. Progressive muscle weakness is the most common symptom. It doesn’t affect thought processes or sense of sight, touch, hearing, taste, or smell. However, later stages can include dementia. It also doesn’t cause incontinence.
With MS, symptoms are more difficult to define because they may come and go. MS can affect taste, vision, or bladder control. It can also cause temperature sensitivity as well as weakness to other muscles. While mood swings are common with MS, mental function remains unaffected in people with ALS.
People with MS and ALS may face memory problems and cognitive impairment.
People with MS can experience severe mental changes, including:
Flare-ups or remissions may increase mood swings and the ability to focus.
For people with ALS, symptoms remain largely physical. In fact, mental function remains intact even when ALS has claimed most of a person’s physical capabilities.
MS is an autoimmune disease. Autoimmune diseases occur when the immune system mistakenly attacks normal, healthy parts of the body as if they were foreign and dangerous. In the case of MS, the body mistakes myelin for an invader and tries to destroy it. Myelin is a protective sheath that coats the outside of the nerves.
ALS is not an autoimmune disease, and its cause is largely unknown. Some possible causes may include:
- gene mutation
- chemical imbalance
- disorganized immune response
A small number of cases are linked to family history and may be inherited.
There’s not a lot of new data on the number of people living with or newly diagnosed with MS. Global estimates are that approximately 2.3 million people worldwide are living with MS.
Approximately 20,000 Americans are living with ALS, and around 6,000 people are diagnosed with it each year in the United States.
There are several risk factors that may affect who develops ALS and MS:
ALS is more common in men than in women. It’s estimated that 20 percent more men develop ALS than women in the United States.
MS is more commonly seen in women. Conservatively, women may be two to three times more likely to develop MS than men. But some researchers suggest that this estimate is actually higher, with women three or four times more likely to develop MS.
ALS is more commonly diagnosed in people between the ages of 40 to 70, though it’s possible to be diagnosed at a younger age. The average age at time of diagnosis is 55.
MS is often diagnosed in people a little younger, with the typical age range for diagnosis between 20 to 50 years old. As with ALS, it’s possible to be diagnosed with MS at a younger age.
Additional risk factors
Family history seems to increase risk for both conditions. There’s no ethnic or socioeconomic risk factor for ALS or MS. For unknown reasons, military veterans are about twice as likely to develop ALS as the general public.
More research is needed to better understand the causes for both conditions.
It’s very difficult to diagnose either ALS or MS, especially early in the disease. To make a diagnosis, your doctor will ask for detailed information about your symptoms and your health history. There are also tests they can do to help make a diagnosis.
If ALS is suspected, your doctor may order electrodiagnostic tests, such as an electromyography or nerve conduction velocity test. These tests provide information on the transmission of nerve signals to your muscle.
Your doctor may also order blood and urine studies, or perform a spinal tap to examine spinal fluid. MRI scans or X-rays may be ordered. If you have an MRI scan or X-ray, your doctor may inject a dye into you to increase visualization of damaged areas. A muscle or nerve biopsy may be recommended.
Doctors can use MRI results to distinguish between MS and ALS. MS targets and attacks myelin in a process called demyelination, which an MRI scan can detect. This prevents the nerves from performing as well as they once did. On the other hand, ALS attacks the nerves first. In ALS, the demyelination process begins later, after the nerves have begun to die.
The treatments currently approved by the FDA for MS are only effective for those who have a relapsing form of the disease. Anti-inflammatory drugs such as cortisone may help block the autoimmune response. Disease-modifying drugs are available in both injectable and oral forms. These seem to be effective in improving outcomes for relapsing forms of MS.
A lot of research and effort is being put into finding treatments for the progressive forms of the disease. Researchers are also working hard to find a cure.
Lifestyle treatments for MS focus primarily on stress reduction. Chronic stress is believed to worsen the neurologic symptoms and increase the number of brain lesions. Lifestyle treatment includes mindfulness. Mindfulness reduces stress and allows for better coping methods in stressful situations.
MS attacks or relapses can come without warning, so it’s important to be willing to adapt your activities to how you feel on a given day. However, staying as active as possible and continuing to socialize can help with symptoms.
As with MS, there’s no cure for ALS. Treatments are used to slow symptoms and prevent some complications. The only FDA-approved drug to treat ALS is riluzole (Rilutek). For some, it seems to slow the disease’s progression. However, there are other drugs that can help manage other symptoms like constipation, fatigue, and pain.
Physical, occupational, and speech therapy can help manage some effects of ALS. When breathing becomes difficult, you can get devices to assist. Psychological support is also important to help you emotionally.
Each condition has a different long-term outlook.
Outlook for MS
MS symptoms usually develop slowly. People with MS may go on to live relatively unaffected lives. Symptoms of MS may come and go, depending on the type of MS you have. You may experience an attack, and then symptoms disappear for days, weeks, even years.
The progression of MS differs from person to person. Most people with MS fall into one of these four levels of the disease:
Relapsing-remitting MS: This is the most common form of MS. Relapses are followed by full or almost full recovery. There’s little or no progression of disease after attacks.
Secondary-progressive MS: This is the second stage of RRMS. The disease begins to progress after attacks or relapses.
Primary-progressive MS: Neurologic function begins to worsen from the very beginning of the disease. Progression varies and levels off from time to time. You may experience only minor remissions.
Progressive-relapsing MS (PRMS): Progression of the disease is steady from the beginning. It includes attacks or relapses, but no remission from these. This level isn’t as common as the other three.
Outlook for ALS
ALS symptoms usually develop very quickly, and it’s a terminal condition. The 5-year survival rate, or the number of people still living 5 years after being diagnosed, is 20 percent. The average survival rate is 3 years after diagnosis. Up to 10 percent survive more than 10 years.
According to the National Institute of Neurological Disorders and Stroke, eventually all people with ALS will become unable to walk, stand, or move about without help. They also may develop great difficulty swallowing and chewing. Ultimately, ALS is fatal.
Though both diseases appear to have much in common during the earliest stages, the progression, treatments, and outlook for ALS and MS are very different. However, in both cases treatment paves the path toward a healthier, more fulfilling life as long as possible.
People with either condition should talk to their doctor about developing a treatment. Your doctor can also prescribe medication that can help manage symptoms.
You asked, we answered
- I have initial symptoms of both MS and ALS. What tests or procedures are done to determine diagnosis?
MRI is often used to distinguish between MS and ALS. In MS, demyelination of the nerves begins and results in nerve changes. In other words, the loss of myelin coating of the nerve occurs first in MS, and then a loss of nerve function. In ALS, nerves are damaged by an unknown cause, and then the damaged nerves lose their coating or myelin. By looking for demyelination using MRI, a doctor can often tell the difference between the two diseases, as signs of demyelination often occur well after symptoms have progressed in ALS. Finally, there is no single definitive test to distinguish between the two, but signs, symptoms, and imaging are often used to come to a conclusion.- George Krucik, MD, MBA