Symptoms: Multiple Sclerosis vs. Autonomic Nervous System Disorders

Multiple Sclerosis or Autonomic Nervous System Dysfunction

Hello Dr.
Jiang, I have been experiencing a tingling and numbness in my hands and feet since early September.
I visited a neurology clinic, and they suggested it could be either cervical spine inflammation or autonomic nervous system dysfunction.
I previously had a stomach ulcer that caused a sensation of something stuck in my throat for several months, and later I developed symptoms like chest tightness, frequent urination, irregular menstrual cycles, and migraines.
I have been concerned that I might indeed be suffering from autonomic nervous system dysfunction.
I underwent blood tests, EEG, and nerve conduction studies at a major hospital, all of which returned normal results.
Gradually, most of my physical issues improved, but the tingling and numbness in my hands and feet persisted.
Recently, my palms and fingers have been so numb that I wake up at night and feel numb as soon as I open my eyes.
In November, I started feeling a tingling sensation in the soles of my feet while walking, as if they were enveloped in numbness.
Additionally, certain positions, like crossing my legs or sitting cross-legged, cause my feet to go numb quickly, and I sometimes feel an electric shock sensation in my back.

Since learning about multiple sclerosis, I have been quite anxious.
However, I consulted a neurologist who specializes in this condition, and they reassured me that my symptoms do not indicate multiple sclerosis.
They suggested that my symptoms are more likely due to autonomic nervous system dysfunction and prescribed medication to improve peripheral neuropathy, which has helped reduce the numbness in my hands.
However, I still occasionally experience numbness in my feet, and the tingling pain in the soles persists.
Recently, I have also experienced sudden itching in my hands and feet that lasts about 1 to 3 seconds, along with occasional burning sensations in my legs.

I feel that my symptoms are very similar to those of multiple sclerosis, and being 21 years old, I am at an age where this condition is more likely to occur.
While other issues have improved, the numbness remains, which makes me very anxious.
I try to distract myself from focusing too much on my health by engaging in other activities, including traveling, but the symptoms continue to persist.
I am currently hesitant about whether I should pay out of pocket for an MRI.
I recently asked a doctor for their opinion, as you have always provided me with detailed information rather than just sending me directly to a hospital for consultation, which I truly appreciate.
However, I am saddened that my health has not yet returned to normal, and I feel exhausted from visiting various clinics.
I hope that after reviewing my recent symptom changes, you can provide me with some advice.
Thank you very much!

Ms. Li, 20~29 year old female. Ask Date: 2022/01/23

Dr. Jiang Junyi reply Neurology

Dear Miss Li,
You mentioned that "the symptoms really seem very similar to those of multiple sclerosis, and considering that I am 21 years old, which is the age when this condition is more likely to occur..." I believe the chances are low, as multiple sclerosis is classified as a rare disease.
The symptoms of multiple sclerosis can vary significantly among different patients.
The specific symptoms depend on the location of the plaques or lesions within the central nervous system.
For example, lesions in the optic nerve can lead to visual disturbances, while damage to the spinal cord can result in weakness and sensory loss in the upper and lower limbs.
Diagnosis: Clinical diagnosis is based on laboratory test results, such as magnetic resonance imaging (MRI), visual evoked potentials (VEP), and cerebrospinal fluid (CSF) analysis.
As you mentioned, "considering paying out of pocket for an MRI," this can assist in the diagnosis.
If there are no signs of brain lesions, you shouldn't worry too much.

Regarding your concern that "all other issues have improved except for this persistent numbness, which has caused me a lot of anxiety," I recommend consulting a neurologist specializing in peripheral nerves, as they have more experience with nerve conduction studies and electromyography.
Thank you for your inquiry.
Feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi
Department of Neurology
Taoyuan Hospital

Reply Date: 2022/01/23

More Info

Multiple sclerosis (MS) and autonomic nervous system disorders can present with overlapping symptoms, which can lead to confusion and anxiety for patients. Understanding the differences between these conditions, as well as the appropriate care and treatment options, is crucial for effective management.

Symptoms of Multiple Sclerosis
MS is a chronic autoimmune disease that affects the central nervous system (CNS), leading to demyelination of nerve fibers. Common symptoms include:
1. Sensory Disturbances: Patients often report numbness, tingling, or a "pins and needles" sensation in the limbs. This can be similar to what you are experiencing with your hands and feet.

2. Motor Symptoms: Weakness or difficulty in coordination and balance can occur, potentially leading to mobility issues.

3. Visual Problems: Blurred or double vision, as well as episodes of vision loss, are common.

4. Fatigue: A profound sense of tiredness that is not relieved by rest.

5. Cognitive Changes: Some patients may experience memory issues or difficulty concentrating.

6. Autonomic Symptoms: This includes bladder dysfunction, sexual dysfunction, and changes in bowel habits.

Symptoms of Autonomic Nervous System Disorders
Autonomic nervous system disorders can lead to a variety of symptoms, including:
1. Cardiovascular Issues: Such as orthostatic hypotension (a drop in blood pressure when standing), which can cause dizziness or fainting.

2. Gastrointestinal Symptoms: Including issues with digestion, constipation, or diarrhea.

3. Temperature Regulation Problems: Difficulty in regulating body temperature can lead to excessive sweating or feeling too hot or cold.

4. Bladder Dysfunction: Similar to MS, but often more related to the autonomic control of bladder function.

Diagnosis and Differentiation
Given your symptoms, it is understandable to be concerned about MS, especially since you are in the age group where it is commonly diagnosed. However, the fact that you have seen a neurologist who has reassured you that your symptoms are more consistent with autonomic nervous system dysfunction is a positive sign.
Diagnostic tools such as MRI scans can be instrumental in identifying lesions characteristic of MS. If your neurologist has suggested that your symptoms are due to autonomic dysfunction and has prescribed medication to help with peripheral neuropathy, it indicates a different underlying issue.

Treatment and Care
1. Medication: For MS, disease-modifying therapies (DMTs) are often prescribed to reduce the frequency and severity of attacks. In contrast, treatment for autonomic dysfunction may include medications to manage specific symptoms, such as those for neuropathic pain or to improve blood flow.

2. Physical Therapy: Engaging in physical therapy can help improve mobility and strength, which is beneficial for both MS and autonomic disorders.

3. Lifestyle Modifications: Stress management techniques, regular exercise, and a balanced diet can help manage symptoms. Since you mentioned anxiety about your health, incorporating mindfulness practices or cognitive behavioral therapy (CBT) may also be beneficial.

4. Follow-Up: Regular follow-ups with your healthcare provider are essential. If your symptoms persist or worsen, further evaluation, including MRI, may be warranted to rule out MS or other neurological conditions.

Conclusion
While your symptoms may seem alarming, it is essential to focus on the guidance provided by your healthcare team. They are best equipped to assess your condition based on clinical evaluations and diagnostic tests. If you continue to experience anxiety about your health, consider discussing this with your doctor, who may refer you to a mental health professional for additional support. Remember, early intervention and a comprehensive care plan can significantly improve your quality of life, regardless of the underlying condition.

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