Difference between ALS and multiple sclerosis


Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) , also known as Lou Gehrig's disease, are lifelong neurological conditions associated with muscle weakness and physical disability. Although they have similar names, there are significant differences between them.

MS is not life threatening and life expectancy can be the same as that of anyone without the disease. ALS, on the other hand, requires major interventions to sustain life and is ultimately fatal.

While neither of these are curable, significant advances have been made in the medical care and treatment of both conditions.


Neurological symptoms are the hallmark of multiple sclerosis and amyotrophic lateral sclerosis, and although the symptoms overlap, there are significant differences between the two .

Ellen Lindner / Get Medication Information

Muscle weakness or problems speaking (dysarthria) or swallowing (dysphagia) are some of the first symptoms of ALS. On the contrary, the first symptoms of multiple sclerosis are usually paresthesias (numbness or tingling in the extremities) or changes in vision.

But any of these conditions can start with mild problems, such as a twitch of an arm, or a serious event, such as weakness in the legs and a sudden fall.

ALS is characterized by a steady decrease and worsening of symptoms. In contrast, some types of MS are characterized by a gradual decline, while others are characterized by periods of remission (improvement) and exacerbations (relapses ).

Symptom ALS RS
Weak muscles (arms and legs) Yes Yes
Paralysis Yes Rare
Conversation problems Yes Yes (less serious)
Cognitive problems Yes (less often) Yes
Humor changes Yes (less often) Yes
Swallowing problems Yes Yes (less serious)
Respiratory problems Yes Rare
Vision changes No Yes
Sensory problems Rare Yes
Bladder / bowel problems Yes Yes

Weakness of the muscles of the arms and legs.

ALS always leads to muscle paralysis (complete weakness). Muscles atrophy (shrink and collapse) over time. After all, anyone with ALS will need an assistive device, such as a walker, wheelchair, or scooter.

Many people with multiple sclerosis experience mild to moderate muscle weakness, but only occasionally experience paralysis. MS can affect the way you walk and you may need an assistive device to get around, but most people with MS are more independent than people with ALS.

Conversation problems

Dysarthria is common in ALS and MS. Dysarthria does not affect your understanding of words because it is not a language disorder. His speech may be difficult to understand and he may also drool, especially when speaking.

Dysarthria is generally more serious in ALS than in MS.

Cognitive problems

MS can cause cognitive dysfunction , which often presents with blurred or slow thinking. It can be intermittent or progress throughout the course of the disease.

ALS can also have cognitive and behavioral dysfunction that is exacerbated by progressive disease, but less frequently compared to patients with multiple sclerosis.

Mood or personality changes

MS can cause changes in mood and personality through its direct effects on the brain.

ALS can also be associated with depression, anxiety, and personality changes, but these tend to be less common in patients with multiple sclerosis.

Swallowing problems

ALS generally causes dysphagia. This often goes so far as to require a feeding tube or other means of feeding.

Although swallowing problems associated with MS can occur, they are generally less severe and can generally be treated with swallowing therapy and dietary adjustments.

Respiratory problems

ALS generally causes respiratory problems due to degeneration of the nerves that supply the respiratory muscles. Most people with ALS require a device to help them breathe, often starting with noninvasive ventilation (a mask that delivers oxygen) and then moving on to mechanical ventilation, which uses mechanical ventilation to support lung function.

Respiratory problems are rare in multiple sclerosis and are usually mild. The breathing problems associated with multiple sclerosis rarely require respiratory assistance.

Vision changes

In multiple sclerosis, vision can be affected by optic neuritis or nystagmus . In fact, decreased vision, double vision, and blurred vision are common in multiple sclerosis and often affect the ability to drive.

ALS does not affect vision, but it can cause changes in eye movement in the later stages of the disease.

Sensory symptoms

Sensory changes are common in MS and can present with a variety of complaints, such as numbness, tingling, or pain .

Some people with ALS report tingling sensations. However, this is rare and usually goes away.

The tingling or sensory discomfort in ALS is caused by pressure and prolonged immobility, not by the disease itself.

Bladder and bowel symptoms

It is estimated that more than 90 percent of people with multiple sclerosis suffer from bladder dysfunction , including the inability to initiate urination and / or urinary incontinence. People with ALS may lose motor control and may experience urinary and bowel incontinence.

Both multiple sclerosis and amyotrophic lateral sclerosis are commonly associated with constipation .


Both conditions affect the brain and spine. However, in MS, demyelinating lesions can be seen in the brain and spinal cord on MRI, while in ALS, neuronal damage cannot be seen on images. MS, but not ALS, can also affect the optic nerves (the nerves that control vision). Furthermore, the pathophysiology of the disease (biological changes) of the two conditions is completely different.

The cause of multiple sclerosis.

MS is a disease caused by demyelination of the nerves in the brain, spine, and optic nerves. Myelin is the fatty membrane that insulates the nerves and allows them to function efficiently. Nerves do not work as well as they should when they lack enough myelin and this leads to multiple sclerosis symptoms.

Myelin is replaced regularly and can cure a relapse with no residual effects. Sometimes nerve damage or scarring can occur, and neurological deficits can be long-term or permanent.

The demyelination of multiple sclerosis is believed to be caused by an autoimmune reaction in which the body attacks its own myelin. MS can have hereditary and environmental components, but the reason remains a mystery .

Cause of ALS

In ALS, the motor neurons and their tracts (corticospinal and corticobulbar) located in the brain, trunk, and spinal cord are gradually damaged, causing muscle weakness and atrophy (contraction). ALS is not believed to have an autoimmune cause, but it is not clear exactly why the disease occurs.


Your physical exam may show some overlapping features. For instance:

  • Both multiple sclerosis and amyotrophic lateral sclerosis can cause increased reflexes.
  • In any condition, your engine's power can be reduced.
  • Both can affect one or both sides of your body.
  • Your muscle tone can increase or decrease with any condition.

With multiple sclerosis, you may experience a change in sensation anywhere in your body (although this may not happen), but your sensory exam should be normal for ALS.

ALS is often characterized by muscle twitching, which resembles the rapid fluttering of small muscles on the tongue, lips, or any other part of the body. With multiple sclerosis, you may have muscle spasms, which are noticeable involuntary contractions of the muscles. Spasms can develop in the later stages of ALS.

Because of this, testing is necessary. You can run the same diagnostic tests if you have one of these two conditions, but the results will be completely different.


Your diagnostic tests can help you differentiate between the two. MS is characterized by abnormalities that can be seen on magnetic resonance imaging (MRI) of the brain or spinal cord, whereas these tests are not affected by ALS.

ALS is characterized by changes in the patterns seen on electromyography (EMG) , whereas MS patients have normal findings.

And, if you have a lumbar puncture (lumbar puncture) , the results may show a characteristic pattern of multiple sclerosis that is not seen with ALS.

Watch out

Treatment for these conditions is quite different, but both diseases are treated with modifying therapy and with therapy aimed at treating complications.

Disease modification therapy

Disease-modifying therapy for multiple sclerosis (DMT) is used regularly to prevent flare-ups and general neurological deterioration. There are also treatments used during an exacerbation of multiple sclerosis, including corticosteroids.

A new treatment for ALS, Radicava (edaravone) , was approved by the US Food and Drug Administration (FDA) in 2017. This drug is believed to prevent nerve damage by preventing disease progression. Since this is relatively recent, the impact on people with ALS is not yet known .

Disease treatment

In both conditions, support for medical complications and disabilities is an important part of medical care.

For example, physical therapy can help you optimize swallowing and motor skills. A supportive brace can help you walk or use your hands. Preventing pressure ulcers, respiratory infections, and malnutrition is essential, and strategies to address these issues can be incorporated into your care over time.

Adaptation to bladder and bowel problems may be required, as well as medications used to prevent painful spasms.

Get the word of drug information

If you or your loved one experience any neurological symptoms, be sure to speak with your doctor. There are many neurological diseases, and although the idea of having one of them may seem overwhelming, keep in mind that many neurological diseases are quite treatable.

An early diagnosis is your best chance to improve your long-term recovery. And even for a condition as serious as ALS, recent advances in treatment have improved median survival.

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