Can You Have Both MS and Parkinson’s Disease?

Yes, a person can have both multiple sclerosis (MS) and Parkinson’s disease, and doctors have described such cases. But having MS does not appear to make Parkinson’s more likely, so when both show up it is usually two separate conditions meeting by chance. New shaking or stiffness in someone with MS has several possible explanations, and working out which one applies decides the treatment.

How Often MS and Parkinson’s Occur Together

The best numbers come from Denmark. Among more than 15,000 people with MS, 26 developed Parkinson’s, almost exactly the 26 or 27 expected in the general population.1PubMed. Multiple sclerosis and risk of Parkinson’s disease: a Danish nationwide cohort study The risk looked the same for women and men with MS.2PubMed. Multiple sclerosis and risk of Parkinson’s disease: a Danish nationwide cohort study It also held after the researchers allowed for the years Parkinson’s can go unnoticed before it is diagnosed.3PubMed. Multiple sclerosis and risk of Parkinson’s disease: a Danish nationwide cohort study A diagnosis of MS is not, in itself, a reason to expect Parkinson’s later. Most new tremor or stiffness in someone with MS is still more likely to come from MS or from a medicine, so the worry deserves a check-up, not alarm.

Some people will have both simply by chance. Both are common brain conditions, Parkinson’s grows more common with age, and people with MS live for decades after diagnosis.

When both do happen, MS usually comes first. In one group of eight people with both conditions, MS always appeared first.4PubMed Central. Parkinsonism associated with multiple sclerosis: A report of eight new cases and a review on the literature MS began at about age 33 on average, and Parkinson-like symptoms followed at about 39.5PubMed Central. Parkinsonism associated with multiple sclerosis: A report of eight new cases and a review on the literature MS usually starts in young adulthood and Parkinson’s later in life, so this order is what timing alone would predict.

MS Tremor Versus Parkinson’s Tremor

Multiple sclerosis is the most common cause of intention tremor, a shake that grows as the hand nears a target, like reaching for a cup.6PubMed Central. The Differential Diagnosis and Treatment of Tremor Parkinson’s typically causes a rest tremor, a shake that appears when the hand is relaxed and often starts on one side.7PubMed Central. The Differential Diagnosis and Treatment of Tremor In Parkinson’s, the tremor at rest usually comes with stiffness and slowness of movement.8PubMed Central. The Differential Diagnosis and Treatment of Tremor

So the most useful thing you can tell your neurologist is when the shaking happens. Check whether it shows up with your hand resting in your lap, which points more toward Parkinson’s, or appears or worsens as you reach, which points more toward MS. Notice whether it started on one side, since Parkinson’s tremor often begins in one hand and may stay uneven for a long time. Look for smaller, slower movement, such as handwriting that shrinks across a line or buttons becoming harder, because slowness is a key part of Parkinson’s that tremor alone does not show. A short phone video of the tremor in different positions helps, because it often does not appear on cue in the clinic.

Stiffness can mean different things too. MS often causes spasticity, a tight, springy stiffness of the legs, along with brisk reflexes. Parkinson’s causes rigidity, an even resistance that can feel like a ratchet when a doctor moves the arm.9PubMed Central. Co-occurrence of multiple sclerosis and Parkinson disease One woman with long-standing MS developed both kinds at once: spasticity in her legs, and ratchet-like rigidity and tremor in her hands.10PubMed Central. Co-occurrence of multiple sclerosis and Parkinson disease

Several other symptoms overlap and cause confusion. Fatigue, poor balance and falls occur in both conditions, so having them does not tell you which disease is behind them, and it does not mean you have both. Anxiety and pain are common in both and can feed each other, which can make tremor and stiffness feel worse during stressful times without any change in the underlying disease.11PubMed Central. Directional Symptom Dependencies in Multiple Sclerosis and Parkinson’s Disease: A Comparative Bayesian Network Analysis

Three Ways Parkinson-Like Symptoms Arise in MS

Parkinsonism is the cluster of tremor, stiffness and slowness, whatever its cause. In a group of people with MS who were followed over time, the causes broke down like this:

The breakdown above comes from a small group, so it shows what is most common there, not a rule for every individual.

MS can occasionally be the cause. Damage in the deep brain areas that control movement can produce Parkinson-like symptoms.15PubMed Central. Parkinsonism associated with multiple sclerosis: A report of eight new cases and a review on the literature One woman with primary progressive MS had these symptoms as the only sign that her MS was worsening, with MS damage visible in those deep areas.16PubMed. Parkinsonism in multiple sclerosis patients: A prospective observational study In another person with progressive MS, a dopamine scan showed the brain’s dopamine supply falling 4 to 7 times faster than normal aging over four years.17PubMed Central / Elsevier. Progressive dopaminergic defect in a patient with primary progressive multiple sclerosis

Medicines are the other cause worth checking. Some anti-nausea and antipsychotic medicines block dopamine in the brain, which can produce tremor, stiffness and slowness that look like Parkinson’s. People with MS may see several doctors, so one prescriber may not know what another has started. Bring a complete list of everything you take, including over-the-counter products. Symptoms caused by a drug often ease after it is stopped or changed, though recovery can take time. Never stop a medicine on your own, since stopping some drugs suddenly can cause problems, and your doctor can choose a safer replacement.

Ordinary Parkinson’s usually responds well to standard Parkinson’s drugs. A drug side effect may fade once the medicine is changed, so the best treatment can be adjusting a prescription. Symptoms from MS damage point toward reviewing how active the MS is and whether its treatment should change.

How Doctors Tell Which It Is

A typical evaluation moves in steps. The neurologist starts with your history, asking when the tremor and slowness began, which side was first, and whether it came on gradually or alongside an MS relapse. They then examine you, testing muscle tone, reflexes and how fast and evenly you can tap your fingers. Next they review your medicines for any that block dopamine, since changing one may solve the problem.

Imaging comes next. An MRI can show whether MS damage sits in the deep movement areas of the brain.18PubMed. Parkinsonism in multiple sclerosis patients: A prospective observational study A DaT scan is a dopamine scan that shows how much dopamine machinery is left in the brain. A normal dopamine scan together with MS damage in the movement areas pointed to MS as the cause in one case.19PubMed. Parkinsonism in multiple sclerosis patients: A prospective observational study An abnormal scan without such MS damage leans toward ordinary Parkinson’s.

Response to treatment is also a clue. Parkinson’s that arrives by chance responds to levodopa.20PubMed Central. Movement Disorders in Multiple Sclerosis: An Update A clear improvement over several weeks of levodopa therefore supports ordinary Parkinson’s, though a poor response does not settle the question on its own.

When the picture is mixed, ask for a movement disorder specialist. MS neurologists and movement disorder specialists focus on different conditions, so each brings different experience in reading an overlapping picture. A referral is especially useful when your symptoms do not fit neatly, and you can ask whether your MS team will share records and coordinate with the specialist.

Treatment When You Have Both

Levodopa is the main Parkinson’s medicine; the body turns it into dopamine.21PubMed. The two faces of L-DOPA: benefits and adverse side effects in the treatment of Encephalitis lethargica, Parkinson’s disease, multiple sclerosis and amyotrophic lateral sclerosis Symptoms caused by a lack of dopamine often ease quickly on it.22PubMed. The two faces of L-DOPA: benefits and adverse side effects in the treatment of Encephalitis lethargica, Parkinson’s disease, multiple sclerosis and amyotrophic lateral sclerosis Symptoms caused by other damage do not respond the same way.23PubMed. The two faces of L-DOPA: benefits and adverse side effects in the treatment of Encephalitis lethargica, Parkinson’s disease, multiple sclerosis and amyotrophic lateral sclerosis

Levodopa does not treat MS itself, so it is added alongside MS therapy and does not replace it. Doses are usually raised gradually over weeks, so judging the benefit too early can be misleading.

Treatment that slows MS continues, as it did for one woman who stayed on interferon for years.24PubMed Central. Co-occurrence of multiple sclerosis and Parkinson disease Researchers are exploring treatments that calm brain inflammation and might help in both diseases, but none is established yet.25PubMed Central. Immunological dimensions of neuroinflammation and microglial activation: exploring innovative immunomodulatory approaches to mitigate neuroinflammatory progression

With two specialists involved, coordination matters. Make sure each doctor knows every medicine the other prescribes, because drugs for one condition can affect the other. Ask whether any medicine you take for MS symptoms, such as for spasticity or bladder, could worsen movement or dizziness. Report new side effects promptly, such as dizziness on standing, nausea, or sudden extra movements after levodopa doses.

Therapy and Support for Daily Life

Physical therapists use cues such as rhythm or lines on the floor, treadmill work and stride exercises to improve walking.26DeRosa Physical Therapy. Physical Therapy for Neurological Conditions – Parkinson’s Disease and Multiple Sclerosis These approaches can lower the risk of falls.27DeRosa Physical Therapy. Physical Therapy for Neurological Conditions – Parkinson’s Disease and Multiple Sclerosis Core, balance and strength work helps keep independence, and pacing your activity helps you manage fatigue.28DeRosa Physical Therapy. Physical Therapy for Neurological Conditions – Parkinson’s Disease and Multiple Sclerosis

To get started, ask your doctor for a referral to a physical therapist who works with neurological conditions, since they know the movement and fatigue problems of both diseases. Bring notes on recent falls or near-falls, including when and where they happened, so the therapist can target the real risks. Expect to leave with a home exercise plan, because progress depends on practice between visits. Ask your doctor to reassess your needs as symptoms change, since the right exercises may shift.

Anxiety is common in both conditions and can worsen pain,29PubMed Central. Directional Symptom Dependencies in Multiple Sclerosis and Parkinson’s Disease: A Comparative Bayesian Network Analysis so treating it may ease other symptoms too. Palliative care, at home or in clinic, improves life for people with MS or Parkinson’s and for their caregivers.30PubMed. Palliative care to support the needs of adults with neurological disease It is support with symptoms and planning, not only end-of-life care.

Family members carry some of the load. Two diagnoses add appointments, medicines and worry, and caregiver strain is real and worth addressing early. Support groups for each disease can offer practical tips and a sense that others understand, and palliative teams can include the caregiver’s needs in the plan.