Diagnosis of Multiple Sclerosis

Multiple Sclerosis (MS) is a disease that makes it known over time. To make the diagnosis, your doctor will have to be aware of more than one MS attack, which occurs in different parts of the nervous system (brain and spinal cord). To determine proof of multiple attacks your doctor will use clinical history, physical examination and testing which may include magnetic resonance imaging (MRI). MRI will be used to view organs, muscles and nerves.

Your doctor may also do a spinal tap to examine spinal fluid to see if it contains distinct proteins called oligoclonal bands. A spinal tap result of normal does not exclude the diagnosis of MS because the disease could be in the early stages. The spinal may rule out other diseases that may mimic the symptoms of MS, diseases such as Lyme disease.

MRI

MRI scans may be used to follow the progress of MS. Lesions can be detected by MRI that do not show up in clinical examination. MRI can be a very useful tool not only in making the diagnosis of MS, but in the treatment planning stage as well as when determining how and when to use therapy.

The diagnosis is facilitated by a clinical analysis of the presenting symptoms, which may include: numbness, weakness, visual impairment, dizziness, urinary bladder urgency or difficulty, fatigue, depression and balance issues.

Experts Only

The diagnosis should be made by a medical professional who is experienced in making the diagnosis, such as a neurologist. The diagnosis should be based not only upon physical examination and symptom history but also upon testing and evidence of two or more neurological signs that are localized to either the brain or the spinal cord and occur in different parts of the central nervous system (brain and spinal cord).

Magnetic resonance imaging (MRI) with gadolinium contrast can help locate lesions and should be done at 3-month intervals following the initial attack to identify new lesions. MRI can also exclude other diseases that may mimic MS such as vascular diseases or spinal cord compression, as well as vitamin B12 deficiency, syphilis, systemic lupus, sarcoidosis or Lyme disease.

In order to make an accurate diagnosis it is important to get a complete medical history and a through medical examination. The doctor must be skilled at asking the right questions in order to uncover information pertinent to making the diagnosis. The right questions may reveal signs and symptoms of a malfunctioning brain or spinal cord. Besides the MRI, spinal taps and electrical tests may be performed to aid in making the diagnosis. Blood samples may also be needed as well to help with the diagnosis.

Criteria for Diagnosis:

    Onset between ages of 20 to 50 years of age

    Symptoms and signs that indicate a brain or spinal cord involvement

    Evidence of two or more lesions that are seen on MRI scan

    An examination that concurs that there is evidence of disease involving the brain or spinal cord

    Two or more MS episodes that last at least 24 hours each and occur at least one month apart

    No other disease can account for the symptoms