The 7 differences between Multiple Sclerosis and ALS

On more than one occasion we have heard of multiple sclerosis and amyotrophic lateral sclerosis. Although their name is different, as they share "sclerosis" there are those who confuse them or think that they must present the same symptoms.

These are really two different neurological diseases, with different progression, treatments, symptoms and life expectancy, in addition to involving a varied degree of involvement.

Next we will discover what they are the main differences between multiple sclerosis and ALS.

• Related article: "Multiple Sclerosis: Types, Symptoms, and Possible Causes"

Main differences between Multiple Sclerosis and Amyotrophic Lateral Sclerosis

There are two neurological diseases whose names suggest that they are related, and indeed they are. However, both have their particularities that not only affect the symptoms that manifest in those who suffer from them, but also in their treatment, progression and life expectancy. These diseases are multiple sclerosis and amyotrophic lateral sclerosis.

Before seeing the main differences between these two types of sclerosis, it is convenient to make a brief and quick description of both. Multiple Sclerosis (MS) is an autoimmune disease that affects the central nervous system, that is, the spinal cord and the brain. while Amyotrophic Lateral Sclerosis (ALS) is a degenerative neuromuscular disease in which motor neurons are destroyed.

As you can see, both diseases involve alterations at the neurological level, but the way in which it occurs, what causes it and how it affects the life of the patient is what differentiates both medical conditions. Next we will discover what are the differences between multiple sclerosis and ALS.

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1. Symptoms

The first thing we notice differences in are the symptoms of these two neurological diseases. At first his symptoms are similar, sharing several symptoms of which we can highlight:

• Muscle weakness and stiffness
• Difficulty moving limbs
• Motor incoordination

However, as the disease progresses, we can find several symptoms that can help to see if it is a case of MS or one of ALS.

Patients with MS present with motor, sensory and cerebellar symptoms. The first outbreaks of this disease are characterized by mobility problems, having tingling, walking difficulties and ataxia.

As the disease worsens, emotional and cognitive symptoms appear in the form of attacks of anxiety, depression and memory problems, along with more physical problems such as fatigue, visual disturbances, spasms, and problems moving arms and legs.

Instead, in ALS there are usually no cognitive symptoms, but many motor problems do appear which cause the control of voluntary movements of the affected person to progressively decrease. The patient loses strength in the arms and legs and, in the later stages of the disease, difficulties in speaking, swallowing and breathing appear.

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2. Causes

MS and ALS are also differentiated by the causes that are believed to cause them.

The exact cause of MS is not known with certainty, although it is known to be an autoimmune disease which may provide some clues. It has been theorized that the person responsible for this neurological condition could be some pathogen, such as a virus, that would cause the immune system to start attacking myelin and oligodendrocytes. Myelin is the substance that protects nerve fibers, while oligodendrocytes are a type of nerve cell.

The exact cause of ALS is not known either, but it is known that its effects are different since the attack occurs not in the myelin but in the motor neurons. Motor neurons are the cells in charge of controlling voluntary movements and, when these are attacked in the course of ALS, his death ends up causing muscle amyotrophy by not being able to transmit the nerve impulse to the muscles.

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3. Incidence of these two diseases

Another difference is the incidence of these two diseases, multiple sclerosis being more common than amyotrophic lateral sclerosis.

In Spain there are about 47,000 cases of MS, while ALS accounts for about 4,000 in the same country. In Europe, MS has been diagnosed in about 700,000 people while ALS affects about 50,000 families. The prevalence of MS is between 80 and 180 cases per 100,000, while that of ALS is about 2 to 5 cases per 100,000 inhabitants.

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4. Age of onset and gender differences

Multiple sclerosis has a much earlier age of onset than amyotrophic lateral sclerosis. MS appears between the ages of 20 and 40, with a mean age of diagnosis of about 29 years, while ALS usually appears later, between the ages of 40 and 70. Due to how early MS can appear, this disease is considered the second leading cause of non-traumatic disability in young people.

There are also gender differences in terms of the probability of suffering from one or the other. MS is more common in women than men, while ALS appears more in men than women. The exact reason why there are gender differences in the appearance of these diseases is not known.

5. Heritability

Although it has not been shown that MS is hereditary, there is a greater possibility of suffering from this disease if you have a family member who has received the diagnosis. Having a relative with MS is a risk factor for presenting it, especially if it is first degree as parents or siblings.

The heritability of ALS, on the other hand, seems to be a little more proven, since it is known that 10% of the cases of this disease are linked to the mutation of a gene that is inherited from the parents.

• Related article: "Heritability: what is it and how does it affect our behavior?"

6. Disease progression

About 85% of patients with multiple sclerosis have a relapsing-remitting course, with specific outbreaks that remit, having periods with some recovery, either total or partial. The symptoms associated with each outbreak progress for periods ranging from 24 to 72 hours, but then stabilize. There are even cases of people who can go years without presenting any outbreak.

Up to 50% of MS patients may suffer from the so-called secondary progressive form of the disease, with a slow and insidious course after about 10 or 15 years of having presented the first symptoms. 15% of patients with MS present the primary progressive form, which implies a slow and progressive worsening of the disease. Patients with MS can have a life expectancy similar to that of the general population, as long as they receive adequate treatment to control the progress of the disease.

These particularities of MS differ greatly from ALS, since its course is always progressive, without flare-ups followed by periods of stability. However, the speed of deterioration can vary greatly from case to case. Because the worsening is constant, the life expectancy of patients with ALS is about 3 to 5 years from the time of receiving diagnosis, although there are cases of people who have exceeded this life expectancy, such as the famous case of the theoretical physicist and astrophysicist Stephen Hawking.

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7. Treatments

As they are two different diseases, they also require different treatments. There is no cure for MS or ALS, but there are treatments that alleviate symptoms and improve the quality of life for those affected.

At present, effective treatments for MS have only been approved in people with the relapsing-remitting variety. For the primary progressive variety of this same disease there are no effective treatments, although the possibility of using corticosteroids such as dexamethasone has been raised.

The drugs used for people with MS are usually interferons: Avonex, Betaferon, and Rebif. Copaxone, Mitoxantrone (immunosuppressant) and Natalizumab (monoclonal antibody) are also used.

Currently there is only one marketed drug available for ALS patients: Riluzole. It is a glutamate blocker that prevents neurons from being destroyed by the action of that substance.

Regarding non-pharmacological treatments, such as psychotherapy, physical therapy and speech therapy, also There are different options depending on the disease, the degree of deterioration of the patient and how quickly the patient is progressing. disease.