Parkinson’s vs. Multiple Sclerosis: What’s the Difference?
Parkinson’s disease and multiple sclerosis (MS) affect your ability to move your body while also causing involuntary movements.
“Both conditions can cause tremors,” says Michael Levy, MD, PhD, a Mass General Brigham neuroimmunologist. “But these distinct diseases have different causes, diagnostic tests, and treatments.”
Parkinson’s disease and MS are both lifelong, progressive disorders. They affect the brain and spinal cord in the central nervous system. Symptoms get worse over time. While there isn’t a cure (yet) for either disease, treatments can improve quality of life.
Dr. Levy, who serves as research director of the Division of Neuroimmunology and Neuro-Infectious Diseases at Massachusetts General Hospital, explains 5 key differences between Parkinson’s and MS.
1. Parkinson’s disease and MS affect the body in different ways.
Multiple sclerosis is an immune-mediated disease, meaning an abnormal response causes the immune system to attack myelin. Myelin is the fatty substance that surrounds and protects nerves in the brain and spinal cord. The resulting damage affects the brain’s ability to communicate with muscles that control movement, sensation, and vision.
“The trigger may be a virus like the Epstein-Barr virus,” says Dr. Levy, “but we really don’t know what triggers the immune system to attack the brain and spinal cord in people with MS.”
Parkinson’s disease is a movement disorder. It occurs when neurons in an area near the base of the brain deteriorate and die. These neurons make dopamine. This chemical messenger is important for brain signaling that coordinates functions like movements, speech, swallowing, and breathing.
As with MS, experts aren’t sure what causes Parkinson’s disease. Exposure to pesticides and other toxins may trigger the disease. As many as 1 in 10 people with the disease has a family history of Parkinson’s. They inherit a gene change that causes familial Parkinson’s disease.
2. There are differences in age of onset and who’s at risk.
Anyone can develop Parkinson’s disease or MS. But these factors set them apart:
Age of onset: MS usually appears between the ages of 20 and 40. It can also affect children (pediatric MS). Parkinson’s disease usually appears in the early to mid 60s, or even later. It’s extremely rare in children.
Biological sex: MS occurs more often in women or people assigned female at birth (AFAB). Parkinson’s disease occurs more often in men or people assigned male at birth (AMAB).
3. There are differences between Parkinson’s and MS symptoms.
Parkinson’s disease and MS affect everyone differently. The conditions share some symptoms, which is one reason why it’s easy to confuse them. Both conditions can cause muscle weakness, stiffness, or spasms that affect walking. Both conditions also cause fatigue and depression. But certain symptoms are unique to the specific condition.
Multiple sclerosis symptoms
With MS, muscle weakness may start on one side of the body and then affect the entire body. MS can occur in flares (where you have symptoms) and remission (where symptoms are mild or nonexistent).
MS signs and symptoms include:
Balance problems, especially when walking
Chronic or occasional dizziness
Difficulty thinking or remembering
Double vision or other vision problems
Tingling, numbness, or pain in the limbs, face, or torso
Parkinson’s disease symptoms
Parkinson’s disease symptoms often affect one side of the body first before gradually affecting the entire body. Symptoms may be less severe on one side. Unlike MS symptoms, which may come and go, Parkinson’s disease symptoms persist every day.
Signs of Parkinson’s disease include:
Cogwheel rigidity: Stiff, tight muscles can make it difficult to move the arms. When a provider tries to move a patient’s arm, it moves in a short, jerky, ratchet-like motion.
Parkinsonian gait: When walking, people with Parkinson’s disease may lean forward, shuffle their feet, and not swing their arms. They may also stop while walking or hesitate before taking a step.
Slowed movements: Loss of muscle control can slow movements. It can be harder to complete daily activities like washing and dressing. A person may also be less expressive, developing what’s known as a “masked face.”
Tremors: Tremors can cause involuntary shaking in the hands, feet, or jaw. People often make a repetitive “pill-rolling” action, rubbing their thumb and forefinger together.
4. Providers use different tests to diagnose Parkinson’s disease and MS.
There isn’t a definitive diagnostic test for Parkinson’s disease or MS. Providers evaluate symptoms and conduct physical and neurological exams. Certain tests, such as brain MRIs, can help providers make a diagnosis.
Tests to diagnose MS
These tests help providers diagnose MS and rule out conditions that cause similar symptoms:
Evoked potentials test to evaluate the nervous system’s responses to stimulation
Lumbar puncture (spinal tap) to test cerebrospinal fluid for proteins and inflammatory cells associated with MS
Vision tests, such as optical coherence tomography (OCT), to check for vision changes
Tests to diagnose Parkinson’s disease
These tests help providers diagnose Parkinson’s disease and rule out conditions that cause similar symptoms:
Dopamine transporter (DaT) scan to look for changes in the brain’s dopamine system
Genetic testing to check for gene changes that cause inherited forms of Parkinson’s disease
- Single-photon emission computed tomography (SPECT) scan to show which areas of the brain are active and less active
5. Treatments for Parkinson’s disease and MS are different.
Because Parkinson’s disease and MS have different causes and symptoms, their treatments are also different.
MS treatments
“There are approximately two dozen, highly effective FDA-approved drug therapies for MS,” says Dr. Levy.
Disease-modifying medications can reduce the number and severity of immune system attacks on the brain. They minimize symptoms and help slow disease progression. Corticosteroids are a medication that can ease inflammation during an MS flare.
Parkinson’s disease treatments
Your Parkinson’s care team can partner with you to review your best treatment options.
Medications and other therapies for Parkinson’s disease ease symptoms. However, they don’t slow or stop the disease from progressing. Most medications change the amount of dopamine in the brain. Carbidopa-levodopa is the most commonly prescribed dopamine medication for Parkinson’s disease.
Some people with Parkinson’s disease benefit from deep brain stimulation (DBS). A small pulse generator device sends safe electrical impulses to leads (tiny wires) that providers place in the brain. DBS can ease symptoms.
Lifestyle changes such as eating well and doing exercises for Parkinson’s disease can help you manage your condition, too.
Hope for people with Parkinson’s disease and MS
“Tremendous progress in treatments over the last couple of decades are helping to improve a patient’s quality of life,” says Dr. Levy. “Researchers continue to look for new ways to manage and eventually cure these life-changing disorders.”
Physician-scientists at Mass General Brigham are actively participating in the development of:
Foralumab, an experimental nasal spray treatment for MS
Parkinson’s disease cell therapies using immune system T-cells
