Neurological Symptoms: Dysautonomia vs. Multiple Sclerosis

Q: Neurological Symptoms: Dysautonomia vs. Multiple Sclerosis

Hello, Miss：<br>You mentioned experiencing "temporary numbness and tingling in your limbs, which lasts for a few seconds but occurs quite frequently." These symptoms are more indicative of hyperventilation. <br>Hyperventilation can lead to a decrease in carbon dioxide levels in t

Autonomic Nervous System Dysfunction or Multiple Sclerosis?

Hello Dr.
Jiang,
In early September, I experienced brief episodes of numbness and tingling in my limbs, lasting only a few seconds but occurring quite frequently.
I consulted a clinic, and they suggested it might be a cervical spine issue.
However, medication and rehabilitation have not improved my condition.
Recently, I've been experiencing intermittent sharp pain on the right side of my head, along with a persistent foreign body sensation in my right eye.
An ophthalmologist diagnosed it as eye inflammation, but after using eye drops for two weeks, the symptoms remain unchanged.

I came across information indicating that multiple sclerosis is more common in women aged 20-40, which has made me quite anxious.
In the past few days, I've noticed that maintaining a single posture for too long can easily lead to leg numbness, and I sometimes wake up at night due to numbness.
I have scheduled an EEG at the hospital, but I am feeling very anxious and would like to seek your opinion on the likelihood of serious conditions.
Additionally, since my gastric ulcer symptoms began in June, I have been experiencing various health issues.
I had episodes of chest tightness and sharp pain (which have since improved), my menstrual cycle has been irregular, and occasionally, I experience slight facial numbness, although not frequently.
I am also considering whether the numbness in my hands and feet might be related to autonomic nervous system dysfunction.
However, I have seen little information regarding this symptom, so I apologize for the trouble.
Thank you very much.

Yo, 20~29 year old female. Ask Date: 2021/11/25

Dr. Jiang Junyi reply Neurology

Hello, Miss:
You mentioned experiencing "temporary numbness and tingling in your limbs, which lasts for a few seconds but occurs quite frequently." These symptoms are more indicative of hyperventilation.
Hyperventilation can lead to a decrease in carbon dioxide levels in the blood, resulting in an increased pH, a condition known medically as "respiratory alkalosis." This can trigger systemic reactions and symptoms, with common manifestations including vasoconstriction and decreased blood calcium levels.
The reduced blood flow to the brain due to vasoconstriction can cause dizziness and numbness, particularly around the lips and upper limbs.
Air may also enter the gastrointestinal tract, leading to symptoms such as bloating and belching.
Regarding your concern about "multiple sclerosis," it is considered a rare disease in Taiwan, and your symptoms do not closely resemble it.
The diagnosis of multiple sclerosis requires a clinical history and examinations that reveal multiple lesions in the nervous system.
This diagnosis is made after excluding other conditions.
Various laboratory tests can assist in the diagnosis, such as MRI scans of the brain and spinal cord, cerebrospinal fluid analysis, and electrophysiological tests (evoked potentials).
If you are worried, I recommend that you consult a neurologist for further evaluation.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares for you.

Reply Date: 2021/11/25

More Info

Understanding the differences between dysautonomia and multiple sclerosis (MS) is crucial for anyone experiencing neurological symptoms. Both conditions can present with overlapping symptoms, but they have distinct underlying mechanisms and implications for treatment and management.

Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS), which includes the brain and spinal cord. In MS, the immune system mistakenly attacks the myelin sheath, the protective covering of nerve fibers, leading to inflammation and damage. This demyelination disrupts the normal flow of electrical impulses along the nerves, resulting in a wide range of neurological symptoms. Common symptoms of MS include:
1. Sensory disturbances: Patients often report numbness, tingling, or a "pins and needles" sensation in various parts of the body, particularly in the limbs.

2. Motor symptoms: Weakness, spasticity, and coordination problems can occur due to nerve damage.

3. Visual disturbances: Optic neuritis, characterized by pain and temporary vision loss, is a common initial symptom.

4. Fatigue: A profound sense of tiredness that is not alleviated by rest is frequently reported.

5. Cognitive changes: Some patients may experience difficulties with memory, attention, and problem-solving.

In contrast, Dysautonomia refers to a disorder of the autonomic nervous system (ANS), which controls involuntary bodily functions such as heart rate, blood pressure, digestion, and temperature regulation. Dysautonomia can manifest in various forms, including postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope, and others. Symptoms may include:
1. Orthostatic intolerance: Difficulty standing up, leading to dizziness or fainting.

2. Heart rate abnormalities: Rapid heart rate or palpitations.

3. Temperature regulation issues: Inability to regulate body temperature effectively.

4. Gastrointestinal problems: Nausea, bloating, and constipation.

5. Fatigue and weakness: Similar to MS, but often related to blood flow issues rather than direct nerve damage.

Given your symptoms of transient numbness and tingling in the limbs, along with episodes of pain and discomfort in the head and eye, it is understandable to be concerned about MS. However, these symptoms can also be indicative of dysautonomia, especially if they are accompanied by other autonomic symptoms like changes in heart rate or blood pressure, or if they correlate with stress or positional changes.

The fact that your symptoms have persisted despite treatment for cervical spine issues suggests that a more comprehensive evaluation is warranted. The upcoming EEG (electroencephalogram) may help rule out seizure activity or other electrical disturbances in the brain, but it is also important to consider additional diagnostic tests such as MRI of the brain and spinal cord, which can help identify lesions characteristic of MS.

Your mention of gastrointestinal issues and menstrual irregularities could suggest a broader systemic problem, possibly involving dysautonomia. Stress and anxiety can exacerbate both MS and dysautonomia symptoms, leading to a cycle of worsening symptoms and increased anxiety.

In conclusion, while your symptoms warrant careful evaluation for both MS and dysautonomia, it is essential to approach this with a comprehensive view. Consulting with a neurologist who specializes in these conditions can provide clarity. They may recommend further testing, including MRI and possibly lumbar puncture, to assess for MS, while also considering the role of the autonomic nervous system in your symptoms. Managing anxiety and stress through counseling or therapy may also be beneficial as you navigate this challenging situation. Remember, early diagnosis and intervention can significantly improve outcomes in both conditions.

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