Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Peripheral neuropathy(PN) andmultiple sclerosis(MS) are neurological disorders that share several symptoms, including pain andparesthesias (abnormal sensations). Either condition can make it difficult to use your arms and hands or to walk.
Despite these similarities, peripheral neuropathy and MS are completely distinct diseases with different causes and treatments.
Both of them can worsen if they are not medically managed, so it is important to seek medical attention if you experience neurological symptoms. While you may be diagnosed with one of these conditions, it’s possible to also have the other or an entirely different neurological issue as well. This article will explore the symptoms, causes, diagnostic procedures, and treatments of PN and MS.
Verywell / JR Bee
The two conditions share some symptoms, but, in general, MS produces a wider range of symptoms than peripheral neuropathy does.
Both MS and PN can cause tingling, pain, or decreased sensation of the hands, arms, feet, or legs, but patterns and timing differ.
The tingling and other sensory problems of MS tend to affect one side of the body, while both sides generally are affected in peripheral neuropathy in what is described as a “stocking-glove” pattern.
MS is more likely than PN to cause muscle weakness, but some types of peripheral neuropathy can make you weak as well.MS is also much more likely than peripheral neuropathy to cause:
Cognitive (thinking and problem solving) difficulties are only seen in MS patients.
Timing and Pattern
Most patients with MS develop weakness andnumbnessas a part of a flare-up, so symptoms usually develop over a couple of days and persist for a few weeks. They tend to improve afterward, especially if you seek medical help and start treatment right away.
MS SymptomsSensory problems tend to affect one side of the bodyMore likely to cause muscle weaknessCognitive difficultiesSymptoms usually develop within days and persist for a few weeks, tending to improve afterward
Sensory problems tend to affect one side of the body
More likely to cause muscle weakness
Cognitive difficulties
Symptoms usually develop within days and persist for a few weeks, tending to improve afterward
Sensory problems tend to affect both sides of the body
Peripheral neuropathy and MS affect different areas of the nervous system.
MS is believed to occur when the body’s own immune system attacks the myelin (a fatty protective layer that coats nerves) in the central nervous system.
This interferes with the nerves' ability to function properly, resulting in the symptoms of MS. Genetics and environmental factors are believed to contribute to this inflammatory autoimmune demyelination.
A number of conditions can damage the peripheral nerves and lead to peripheral neuropathy. Common causes include:
Some peripheral neuropathies, called mononeuropathies, affect only one nerve, whereas others (polyneuropathies) affect multiple nerves. Furthermore, different neuropathies either result from damage to the axons (nerve fibers) or the myelin.
Affects the central nervous system
Genetics and environmental factors are believed to contribute
Affects the peripheral nervous system
While MS is thought of as primarily thought of as affecting the CNS, there is evidence of effect in the peripheral nervous system as well so its not cut and dry.
Your physical examination is likely to be very different when it comes to peripheral neuropathy and MS. For example, reflexes are decreased or absent in peripheral neuropathy, whereas they are brisk with MS. And MS can cause spasticity, or stiffness of the muscles, while peripheral neuropathy does not.
Also, with peripheral neuropathy, your sensory deficit is almost always worse distally (farther away from your body) than proximally (closer to your body), while this pattern is not present in MS.
Despite those differences, diagnostic tests are often performed to confirm what is causing your symptoms as well as the extent and severity of your illness.
Steps to Getting an MS Diagnosis
Diagnostic Tests
Blood work can be helpful in identifying many of the causes of peripheral neuropathy, but blood tests are usually normal in MS. However, blood tests can identify illnesses that may mimic MS, such as another autoimmune condition or an infection.
Nerve tests likeelectromyography (EMG)and/or nerve conduction velocity (NCV) studies are expected to show signs of peripheral neuropathy, but they are not associated with any abnormalities in MS. In some cases of PN, nerve biopsy can also serve diagnostic purposes.
Magnetic resonance imaging (MRI)typically shows signs of MS, but usually doesn’t show significant changes in people with peripheral neuropathy.
MS DiagnosisPhysical examination looks for spasticity or stiffness of the musclesTests include magnetic resonance imaging (MRI) and lumbar puncturePN DiagnosisPhysical examination looks for decreased or absent reflexes and abnormality on sensory examinationTests usually include electromyography (EMG) and/or nerve conduction velocity (NCV), but not for MS
MS DiagnosisPhysical examination looks for spasticity or stiffness of the musclesTests include magnetic resonance imaging (MRI) and lumbar puncture
Physical examination looks for spasticity or stiffness of the muscles
Tests include magnetic resonance imaging (MRI) and lumbar puncture
PN DiagnosisPhysical examination looks for decreased or absent reflexes and abnormality on sensory examinationTests usually include electromyography (EMG) and/or nerve conduction velocity (NCV), but not for MS
Physical examination looks for decreased or absent reflexes and abnormality on sensory examination
Tests usually include electromyography (EMG) and/or nerve conduction velocity (NCV), but not for MS
Treatment of the underlying disease process differs for MS and peripheral neuropathy, but symptomatic treatment is often the same.
For example, treatment of painful paresthesias in MS and peripheral neuropathy can include:
Besides medication, other pain-alleviating therapies used in both illnesses include:
There are no effective treatments for sensory loss. Occupational therapy and physical therapy may be of some benefit in terms of adjusting to the loss of sensation in both MS and peripheral neuropathy.
Treatment of the diseases themselves differs. A number of MSdisease-modifying treatments (DMTs)are used to prevent progression andMS exacerbations (flare-ups).Exacerbations are typically treated with intravenous (IV) steroids.
Peripheral neuropathy is treated based on the underlying cause.For example, if diabetes is the culprit, then getting your blood sugar under control is a primary goal. If a medication or toxin is causing the side effect, removing or stopping the offending agent is important.
For severe cases of MS or some forms of peripheral neuropathy, intravenous immune globulin (IVIG) therapy may be used. With IVIG therapy, you’ll receive high levels of proteins that work as antibodies (immunoglobulins) to replace your body’s own stores. This procedure helps suppress immune system activity and works to prevent your body from destroying its own cells.IVIG therapy can be very helpful in certain types of neuropathy.
Similar to IVIG,plasmapheresis, which is plasma exchange, can be an option for severe cases of MS and peripheral neuropathy.With this procedure, blood is removed from the body and filtered through a machine so that harmful substances can be removed before the blood is returned to the body. It is less commonly employed than IVIG.
MS TreatmentSymptomatic treatment is often the same as PN, including NSAIDs, antidepressants, and anticonvulsantsTreatment of underlying cause includesdisease-modifying treatments (DMTs)and intravenous (IV) steroidsPlasmapheresis can be used for severe casesPN TreatmentSymptomatic treatment is often the same as MS, including NSAIDs, antidepressants, and anticonvulsantsTreatment varies based on appropriate options for the underlying conditionPlasmapheresis can be used for severe cases
MS TreatmentSymptomatic treatment is often the same as PN, including NSAIDs, antidepressants, and anticonvulsantsTreatment of underlying cause includesdisease-modifying treatments (DMTs)and intravenous (IV) steroidsPlasmapheresis can be used for severe cases
Symptomatic treatment is often the same as PN, including NSAIDs, antidepressants, and anticonvulsants
Treatment of underlying cause includesdisease-modifying treatments (DMTs)and intravenous (IV) steroids
Plasmapheresis can be used for severe cases
PN TreatmentSymptomatic treatment is often the same as MS, including NSAIDs, antidepressants, and anticonvulsantsTreatment varies based on appropriate options for the underlying conditionPlasmapheresis can be used for severe cases
Symptomatic treatment is often the same as MS, including NSAIDs, antidepressants, and anticonvulsants
Treatment varies based on appropriate options for the underlying condition
Although you may be tempted to delay seeing your healthcare provider, nervous system symptoms should not be ignored.
While you’re waiting for your appointment, it’s helpful to keep a log of your symptoms so you can describe them in detail. Include any patterns in their occurrence and aggravating or provoking factors.
Differences Between MS and ALS
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Multiple Sclerosis. National Center for Complementary and Integrative Health.Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases.Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke.Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A. Is MS affecting the CNS only?Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol NeuroinflammJan 2021, 8 (1) e914; doi:10.1212/NXI.0000000000000914Misra UK, Kalita J, Nair PP.Diagnostic approach to peripheral neuropathy.Ann Indian Acad Neurol.2008;11(2):89-97. doi:10.4103/0972-2327.41875Hurwitz BJ.The diagnosis of multiple sclerosis and the clinical subtypes.Ann Indian Acad Neurol.2009;12(4):226-30. doi:10.4103/0972-2327.58276Lo Sasso B, Angello L, Bivoni G, Bellia C, Ciaccio.Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update.Medicina (Kaunas).2019 Jun;55(6):245. doi:10.3390/medicina55060245Ginsberg L,Acute and chronic neuropathies.Medicine (Abingdon).2020 Sep;48(9):612–618. doi:10.1016/j.mpmed.2020.06.009De angelis F, John NA, Brownlee WJ.Disease-modifying therapies for multiple sclerosis.BMJ. 2018;363:k4674. doi:10.1136/bmj.k4674Shehata N. Patient education: Intravenous immune globulin (IVIG) (Beyond the basics).Codron P, Cousin M, Subra JF, et al.Therapeutic plasma exchange in chronic dysimmune peripheral neuropathies: A 10-year retrospective study.J Clin Apher.2017;32(6):413-422. doi:10.1002/jca.21530Additional ReadingSuanprasert N, Taylor BV, Klein CJ, Roforth MM, Karam C, Keegan BM et al.Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis. Mult Scler Relat Disord. 2019 Feb 27;30:284-290. doi: 10.1016/j.msard.2019.02.026.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Multiple Sclerosis. National Center for Complementary and Integrative Health.Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases.Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke.Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A. Is MS affecting the CNS only?Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol NeuroinflammJan 2021, 8 (1) e914; doi:10.1212/NXI.0000000000000914Misra UK, Kalita J, Nair PP.Diagnostic approach to peripheral neuropathy.Ann Indian Acad Neurol.2008;11(2):89-97. doi:10.4103/0972-2327.41875Hurwitz BJ.The diagnosis of multiple sclerosis and the clinical subtypes.Ann Indian Acad Neurol.2009;12(4):226-30. doi:10.4103/0972-2327.58276Lo Sasso B, Angello L, Bivoni G, Bellia C, Ciaccio.Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update.Medicina (Kaunas).2019 Jun;55(6):245. doi:10.3390/medicina55060245Ginsberg L,Acute and chronic neuropathies.Medicine (Abingdon).2020 Sep;48(9):612–618. doi:10.1016/j.mpmed.2020.06.009De angelis F, John NA, Brownlee WJ.Disease-modifying therapies for multiple sclerosis.BMJ. 2018;363:k4674. doi:10.1136/bmj.k4674Shehata N. Patient education: Intravenous immune globulin (IVIG) (Beyond the basics).Codron P, Cousin M, Subra JF, et al.Therapeutic plasma exchange in chronic dysimmune peripheral neuropathies: A 10-year retrospective study.J Clin Apher.2017;32(6):413-422. doi:10.1002/jca.21530Additional ReadingSuanprasert N, Taylor BV, Klein CJ, Roforth MM, Karam C, Keegan BM et al.Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis. Mult Scler Relat Disord. 2019 Feb 27;30:284-290. doi: 10.1016/j.msard.2019.02.026.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Multiple Sclerosis. National Center for Complementary and Integrative Health.Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases.Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke.Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A. Is MS affecting the CNS only?Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol NeuroinflammJan 2021, 8 (1) e914; doi:10.1212/NXI.0000000000000914Misra UK, Kalita J, Nair PP.Diagnostic approach to peripheral neuropathy.Ann Indian Acad Neurol.2008;11(2):89-97. doi:10.4103/0972-2327.41875Hurwitz BJ.The diagnosis of multiple sclerosis and the clinical subtypes.Ann Indian Acad Neurol.2009;12(4):226-30. doi:10.4103/0972-2327.58276Lo Sasso B, Angello L, Bivoni G, Bellia C, Ciaccio.Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update.Medicina (Kaunas).2019 Jun;55(6):245. doi:10.3390/medicina55060245Ginsberg L,Acute and chronic neuropathies.Medicine (Abingdon).2020 Sep;48(9):612–618. doi:10.1016/j.mpmed.2020.06.009De angelis F, John NA, Brownlee WJ.Disease-modifying therapies for multiple sclerosis.BMJ. 2018;363:k4674. doi:10.1136/bmj.k4674Shehata N. Patient education: Intravenous immune globulin (IVIG) (Beyond the basics).Codron P, Cousin M, Subra JF, et al.Therapeutic plasma exchange in chronic dysimmune peripheral neuropathies: A 10-year retrospective study.J Clin Apher.2017;32(6):413-422. doi:10.1002/jca.21530
Multiple Sclerosis. National Center for Complementary and Integrative Health.
Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases.
Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke.
Oudejans O, Luchicchi A, Strijbis EMM, Geurts JJG, van Dam, A. Is MS affecting the CNS only?
Lessons from clinic to myelin pathophysiology.Neurol Neuroimmunol NeuroinflammJan 2021, 8 (1) e914; doi:10.1212/NXI.0000000000000914
Misra UK, Kalita J, Nair PP.Diagnostic approach to peripheral neuropathy.Ann Indian Acad Neurol.2008;11(2):89-97. doi:10.4103/0972-2327.41875
Hurwitz BJ.The diagnosis of multiple sclerosis and the clinical subtypes.Ann Indian Acad Neurol.2009;12(4):226-30. doi:10.4103/0972-2327.58276
Lo Sasso B, Angello L, Bivoni G, Bellia C, Ciaccio.Cerebrospinal fluid analysis in multiple sclerosis diagnosis: an update.Medicina (Kaunas).2019 Jun;55(6):245. doi:10.3390/medicina55060245
Ginsberg L,Acute and chronic neuropathies.Medicine (Abingdon).2020 Sep;48(9):612–618. doi:10.1016/j.mpmed.2020.06.009
De angelis F, John NA, Brownlee WJ.Disease-modifying therapies for multiple sclerosis.BMJ. 2018;363:k4674. doi:10.1136/bmj.k4674
Shehata N. Patient education: Intravenous immune globulin (IVIG) (Beyond the basics).
Codron P, Cousin M, Subra JF, et al.Therapeutic plasma exchange in chronic dysimmune peripheral neuropathies: A 10-year retrospective study.J Clin Apher.2017;32(6):413-422. doi:10.1002/jca.21530
Suanprasert N, Taylor BV, Klein CJ, Roforth MM, Karam C, Keegan BM et al.Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis. Mult Scler Relat Disord. 2019 Feb 27;30:284-290. doi: 10.1016/j.msard.2019.02.026.
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