Multiple sclerosis, or MS, is a disabling disorder of the central nervous system. A range of tests can help doctors identify and monitor MS, although no single test or symptom can confirm an MS diagnosis.
Doctors will combine several strategies to check whether a person meets the criteria for MS. Before making a diagnosis of MS, a doctor must exclude the possibility of other conditions. To do this, they may use MRIs, blood tests, and spinal fluid analysis.
It is essential that people with MS receive a prompt and accurate diagnosis. Nerve damage might occur from the very start of disease progression, so it is vital for people to start treatment as soon as possible.
When a person has MS, their immune system attacks myelin, which covers and protects the nerve cells. When the myelin is damaged, scar tissue, or sclerosis, develop, and this interrupts the nerve's ability to send messages back and forth.
In this article, we look at the various strategies a doctor might use to diagnose MS.
No single test can identify MS, so doctors often find the disease challenging to diagnose
The questions the doctor asks, and the ability to critically examine the signs and symptoms a person presents is vital for reaching an accurate diagnosis. The doctor will perform tests to help them assess a person's:
- emotional and psychological state
- language functions and speech
- movement, coordination, and balance
- vision, smell, taste, touch, and hearing
In addition to taking a thorough medical history and physical exam, the doctor may recommend some of the following diagnostic tests to help confirm the diagnosis.
Magnetic resonance imaging (MRI)
MS can cause scar tissue, or plaques, to develop on damaged nerves. An MRI allows the doctor to look for this scar tissue. These abnormal spots can sometimes indicate other conditions, such as migraine or high blood pressure.
The scan uses magnetic fields and radio waves rather than radiation. It measures the relative water content in tissues.
The myelin that protects nerve cells is fatty, and so repels water. When this protective coating incurs damage, it holds more water, which would be visible on an MRI scan.
A doctor must carefully examine an MRI scan to diagnose MS accurately.
An evoked potential is an electrical test of the nerve pathways. It can help a doctor determine which nerve pathways have incurred damage from MS.
The doctor will place wires on a person's scalp and examine the brain's response to specific experiences, such as watching a video screen, hearing a particular noise, or feeling certain sensations. Although the test is highly sensitive, it is harmless and typically painless.
Damaged myelin slows electrical conduction along nerve pathways. This test is particularly useful, as it can find damage in areas of the central nervous system (CNS) that is not responsible for any symptoms.
A lumbar puncture, which doctors also call a spinal tap, is a procedure that involves obtaining cerebrospinal fluid (CSF). This liquid surrounds the brain and spinal cord and can play a vital role in diagnosing MS for some people.
To extract CSF, the doctor inserts a needle between bones in the lower spine. They withdraw fluid using a syringe and then test for antibodies and proteins that may signal an abnormal immune response, such as oligoclonal bands.
Doctors no longer use lumbar puncture as a first-line test. An experienced doctor will decide if a lumbar puncture is needed based on medical history and the outcome of a physical exam.
No blood test can diagnose MS individually.
However, the doctor may order blood testing to rule out other conditions that have similar symptoms.
Blood testing can rule out the following health problems:
When to see a doctor
Anyone experiencing any of the symptoms of MS should seek a prompt and thorough assessment from their doctor.
To confirm a diagnosis of MS, the doctor needs to find evidence of damage in more than one area of the CNS. The damage has to have occurred at least 1 month apart, and a doctor must rule out any other possible causes.
If MS is the cause of a person's symptoms, they should begin treatment as soon as possible to restrict the amount and degree of nerve damage.
According to the Multiple Sclerosis Foundation, early signs and symptoms include:
numbness and tingling in the feet, legs, hands, arms, or face
vision problems, such as blurry or double vision, loss of vision or color contrast, and pain when moving the eye
- difficulty walking
- bladder problems
- sexual problems, for example, reduced sex drive or erectile dysfunction
- problems with memory or speech
- depression and emotional changes
- muscle spasms and tremors
However, symptoms vary from person to person and may change over the course of the disease. Symptoms can also vary depending on which nerves develop plaques and incur damage.
If any of these symptoms occur regularly, seek an evaluation with an MS specialist.
It is essential that people find a specialist who is familiar with treating MS. People with MS require a wide-ranging approach to managing the unpredictable symptoms and disease progression.
Many medications are available to slow disease progression and treat the symptoms associated with the relapsing forms of the disease.
However, only ocrelizumab (OCR) is available to treat primary progressive MS (PPMS).
The use of medications will vary from person to person and will depend on the symptoms, stage, and severity of the disease. Doctors will also prescribe medications to treat relapses as needed.
People with MS could consider taking part in a rehabilitation program that focuses on maintaining strength and function of the body muscles.
Finally, it's important to work with a healthcare provider who recognizes the importance of emotional health and coping mechanisms and can provide the appropriate referrals.
MS is not usually fatal. The primary concern for people with this condition is preserving their quality of life. Many people with the condition will be able to lead a full, active lifestyle.
Although MS is a progressive and often debilitating disease, only some people with MS have symptoms that will eventually progress to permanent disability and mobility issues.
Many advances in the treatment options for MS have occurred in the past decade. New disease-modifying therapies (DMT), such as siponimod (Mayzent) and cladribine (Mavenclad), slow disease progression and decrease disability in people with relapsing forms of MS.
Research continues and offers promising discoveries and treatment for all types of MS.