Clinical Topics   /   Neurology

MS or Chronic Multisymptom Illness? Making the Tricky Diagnosis in Recent Veterans

By U.S. Medicine

By Annette M. Boyle

Source: McAndrew LM, et. al. Iraq andAfghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment. J Rehabil Res Dev. 2016;53(1):59-70.

EAST ORANGE, NJ — Diagnosing multiple sclerosis in its early stages can be difficult in the best of circumstances.

When recent veterans present with symptoms, however, diagnosis becomes even more difficult because another condition with a variety of presentations and symptoms is common in this cohort and could easily be confused with MS early in the course of the disease.

Chronic multisymptom illness, a condition previously associated with veterans of the Persian Gulf War, affects more than 50% of veterans who deployed to Iraq or Afghanistan after 2001, according to research recently published in the Journal of Rehabilitation Research and Development. Both multiple sclerosis (MS) and chronic multisymptom illness (CM) can present with a broad range of similar symptoms and are generally diagnoses of exclusion. 1

MS is a chronic inflammatory, demyelinating disease of the central nervous system. Among the most common early symptoms are fatigue, pain, emotional and cognitive changes, weakness, dizziness, vision problems and bowel and bladder issues, according to the National Multiple Sclerosis Society. More than 50% of individuals with MS report difficulty sleeping, the University of Washington Multiple Sclerosis Rehabilitation Research and Training Center notes.

CMI can look very similar. Among the 319 Army National Guardsmen and Army Reservists who served in Operation Iraqi Freedom and Operation Enduring Freedom in the study, 159 had symptoms consistent with chronic multisymptom illness. Of those, 51.4% reported difficulty sleeping, 50.8% said they were moody or irritable, 46% experienced joint pain, 39.5% reported fatigue, 39.8% had difficulty remembering or concentrating, and 36% suffered from headaches.


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