My husband was diagnosed with multiple sclerosis (MS) in 1999, and now with a second opinion he was diagnosed with possible primary lateral sclerosis (PLS). How does MS differ from PLS? How are MS and PLS diagnosed?
What are the signs and symptoms of multiple sclerosis?
The peak age of onset is between ages 20 and 40, although it may develop in children and has also been identified in individuals over 60 years of age. The most common signs and symptoms include sensory disturbance of the limbs; partial or complete visual loss; acute and subacute motor dysfunction of the limbs; diplopia (double vision); and gait dysfunction. These signs and symptoms may occur alone or in combination, and have to be present for a minimum of 24 hours to be considered a "clinical attack." The signs and symptoms in individuals with MS are extremely variable, even among affected relatives within families. Symptoms vary because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions). While it is common for the disease to return (relapse), the disease may continue to get worse without periods of remission. Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.
Muscle symptoms may include loss of balance, muscle spasms, numbness or abnormal sensation in any area, problems moving arms or legs, problems walking, problems with coordination and making small movements, and tremor or weakness in one or more arms or legs. Bowel and bladder symptoms may include constipation and stool leakage, difficulty beginning to urinate, frequent need or strong urge to urinate, and incontinence. Eye symptoms may include double vision, eye discomfort, uncontrollable rapid eye movements, and vision loss. There may be numbness, tingling, or pain in the face, muscles, arms or legs. Other brain and nerve symptoms may include decreased attention span, poor judgment, and memory loss; difficulty reasoning and solving problems; depression or feelings of sadness; dizziness and balance problems; and hearing loss. Individuals may also have slurred or difficult-to-understand speech, trouble chewing and swallowing, and sexual symptoms such as problems with erections or vaginal lubrication.
Last updated: 3/30/2011
What are the signs and symptoms of primary lateral sclerosis?
The signs and symptoms of primary lateral sclerosis (PLS) often develop between the ages of 40 and 60 and progress (become worse) over time. The voluntary muscles of the legs are often involved first, with symptoms beginning in one leg and then progressing to the other. In general, people with PLS may experience:
Muscle stiffness and spasticity
Difficulty with balance and clumsiness
Problems with speech
Last updated: 4/13/2017
How is multiple sclerosis diagnosed?
Symptoms of multiple sclerosis (MS) may be similar to those of many other nervous system disorders. The disease is made based on the person's signs and symptoms and is typically diagnosed by ruling out other conditions.
"Dissemination in time and space" are commonly-used criteria for diagnosing the relapsing-remitting form of MS (RR-MS). "Dissemination in time means" that there are at least two clinical attacks, each lasting at least 24 hours, separated by at least one month, or a slow, step-wise progressive course for at least six months. "Dissemination in space" means that there are lesions in more than one area of the brain or spinal cord. For primary progressive MS (PP-MS), there are currently no diagnostic criteria that are universally accepted.
Physicians may do many tests to evaluate an individual suspected of having MS.
Neurological Exam: May show reduced nerve function in one area of the body or over many parts of the body. This may include abnormal nerve reflexes, decreased ability to move a part of the body, decreased or abnormal sensation, and other loss of nervous system functions.
Eye Exam: May show abnormal pupil responses, changes in the visual fields or eye movements, decreased visual acuity, problems with the inside parts of the eye, and rapid eye movements triggered when the eye moves.
Other Tests: Lumbar puncture (spinal tap) for cerebrospinal fluid tests, MRI scan of the brain, MRI scan of the spine; nerve function study; and several of blood tests.
The Revised McDonald Criteria, published In 2010 by the International Panel on the Diagnosis of Multiple Sclerosis, include specific guidelines for using MRI, visual evoked potentials (VEP) and cerebrospinal fluid analysis to speed the diagnostic process.
Last updated: 11/21/2015
How is primary lateral sclerosis diagnosed?
A diagnosis of primary lateral sclerosis (PLS) may be suspected based on the presence of characteristic signs and symptoms. Several different medical tests may then be ordered to confirm the diagnosis and rule out other conditions (such as multiple sclerosis and amyotrophic lateral sclerosis) that can be associated with similar features. These tests may include:
Magnetic resonance imaging (MRI) of the brain and spine