Tests to diagnose MS include: Blood tests – mainly to rule out other causes of your symptoms. Magnetic resonance imaging (MRI) – to look for scarring (plaques or lesions) in your brain and spinal cord. Lumbar puncture – to test your cerebrospinal fluid (CFS).
Neurological examination
Your neurologist will look for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and co-ordination, speech and reflexes. These may show whether your nerves are damaged in a way that might suggest MS.
There are no specific tests for MS . Instead, a diagnosis of multiple sclerosis often relies on ruling out other conditions that might produce similar signs and symptoms, known as a differential diagnosis. Your doctor is likely to start with a thorough medical history and examination.
The process of diagnosis can take months, in some cases years, and is often referred to as 'limboland'. In this factsheet we look at the early symptoms of MS and hope to answer some of the common questions that you might have at this time.
First, the neurologist will discuss your medical history with you. They will ask about your symptoms, when they started, how often you experience them, and if anything makes them better or worse. The neurologist will also want to know about your family medical history and any medications you are currently taking.
While there is no definitive blood test for MS, blood tests can rule out other conditions that cause symptoms similar to those of MS, including lupus erythematosis, Sjogren's, vitamin and mineral deficiencies, some infections, and rare hereditary diseases.
Magnetic resonance imaging (MRI) is the test of choice for diagnosing MS in combination with initial blood tests. MRIs use radio waves and magnetic fields to evaluate the relative water content in tissues of the body. They can detect normal and abnormal tissues and can spot irregularities.
People should consider the diagnosis of MS if they have one or more of these symptoms: vision loss in one or both eyes. acute paralysis in the legs or along one side of the body. acute numbness and tingling in a limb.
There is no definite measure or laboratory marker for the diagnosis of MS, yet. Both the clinical features of the disease, and laboratory investigations such as magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analyses are being used.
The first step in diagnosing MS is taking a thorough medical history. Your doctor will ask you about your symptoms, including when they began and whether you've noticed any patterns or triggers. They may also ask you about: injuries, diseases, or other health conditions with which you've been diagnosed.
Immunoglobulin M (IgM)
Intrathecal IgG OCBs are a hallmark of MS and are the most widely used diagnostic biomarker in MS, despite not being specific to MS. In addition, an increased IgG synthetic rate and elevated IgG index are also used as corollary evidence for MS.
Common CSF findings in people with MS include a high level of oligoclonal bands. Oligoclonal bands indicate an increase in autoimmune activity.
MRI scans are an important way to help health care providers figure out if a person has MS or not, but MRI scans cannot diagnose MS by themselves. While it is true that almost all people with MS will have lesions on MRI, not all people with MRI lesions have MS.
Although MRI is a very useful diagnostic tool, a normal MRI of the brain does not rule out the possibility of MS. About 5 percent of people who are confirmed to have MS do not initially have brain lesions evidenced by MRI.
Those symptoms include loss of vision in an eye, loss of power in an arm or leg or a rising sense of numbness in the legs. Other common symptoms associated with MS include spasms, fatigue, depression, incontinence issues, sexual dysfunction, and walking difficulties.
Diagnosis and early intervention
As optic neuritis is the presenting sign of MS in up to 30 percent of patients, the eye exam can lead to the initial systemic diagnosis.
Here's where MS (typically) starts
Optic neuritis, or inflammation of the optic nerve, is usually the most common, Shoemaker says. You may experience eye pain, blurred vision and headache. It often occurs on one side and can eventually lead to partial or total vision loss.
Inflammation in a myelinated portion of the nervous system is the mainstay of multiple sclerosis (MS). Elevation of inflammatory markers such as procalcitonin, ESR and hs-CRP is suspected to occur in MS patients.
CT scans may be used to exclude other causes of neurologic impairment, but they have a low positive predictive value in the diagnosis of MS; thus, the false-negative rate is high.
The basis of MS diagnosis is by determination of "lesions disseminated in space and time”. In other words, MS plaques occurring in multiple parts of the central nervous system (CNS) and over the course of time.
The questionnaire will ask for details on your health history, the condition you are being referred for, and any other conditions for which you are being treated. New patient consults are approximately 45-60 minutes and will include a thorough neurological exam.
For the diagnosis of multiple sclerosis, there should be at least one typical multiple sclerosis lesion in at least two characteristic regions [periventricular (abutting the lateral ventricles), juxtacortical/cortical, infratentorial, spinal cord] to support dissemination in space (Thompson et al., 2018).