Multiple Sclerosis Diagnosis

Multiple sclerosis (MS) is a degenerative disease that affects the nerve cells. In MS, the body’s own immune cells mistakenly attack the protective coating around the nerves. When the coating is damaged, signals from the brain are not able to flow smoothly through those nerves and parts of the nervous system malfunction, leading to the symptoms of MS.

MS is a difficult condition to diagnose because the symptoms can be very different in each person, depending on which nerves are under attack. Sometimes doctors must wait until symptoms worsen before they can make a definitive diagnosis of multiple sclerosis.

MS attacks nerves in the central nervous system which consists of the brain, spinal cord, and the optic nerve which connects the eyes to the brain. Symptoms in different parts of the central nervous system may suggest a diagnosis of MS.

Symptoms your doctor may look for include:

• Abnormal reflexes

• Decreased feeling or abnormal sensations in part of the body, such as not being able to balance due to lack of feeling in the feet

• Decreased ability to move part of the body, such as dragging one foot

• Loss of other nervous system functions

Your doctor may also see these signs of MS during an eye examination:

• Abnormal or unequal response from the pupils of the eyes

• Changes in visual fields, which is a measure of peripheral or side vision while you are looking straight ahead

• Changes in eye movement

• Decreased vision or loss of clear vision

• Problems with the inside of the eye

Because MS is difficult to diagnose, your doctor may first order tests to rule out other possible neurological diseases. Some common tests used to diagnose MS include:

• Blood tests – These tests can rule out infections and inflammatory conditions that have symptoms similar to MS.

• Magnetic resonance imaging (MRI) – Scans of the brain and spinal cord may show areas where the protective coating around the nerves is damaged by MS. However, MRI may not be conclusive because other conditions such as Lyme disease and lupus can cause similar damage to nerves.

• Spinal tap (lumbar puncture) – This test allows the doctor to remove a small amount of fluid from the spinal cord. This test can rule out infections that can cause symptoms similar to MS and can show abnormal levels of white blood cells or proteins that may indicate MS is present.

• Nerve function study – Also known as an evoked potential test, this study measures how well electric signals like those sent from your brain are able to travel through the nerves being tested. This test is usually done to check nerve function in the arms or legs.

In order to make a definite diagnosis of multiple sclerosis, your doctor will need to do these three things:

1. Recognize damage in at least two different areas of the central nervous system

AND

2. Determine that two separate incidents of nerve damage took place at least a month apart

AND

3. Rule out other possible neurological diseases or other conditions.

Sources:

National Multiple Sclerosis Society. Diagnosing MS. Web. November 20, 2011.
http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/diagnosing-ms/index.aspx

Medicine Net. Multiple Sclerosis. Fernando Dangond, MD. Web. November 20, 2011.
http://www.medicinenet.com/multiple_sclerosis/page4.htm#6howis

Mayo Clinic. Multiple sclerosis. Web. November 20, 2011.
http://www.mayoclinic.com/health/multiple-sclerosis/DS00188/DSECTION=tests-and-diagnosis

PubMed Health. Multiple sclerosis. Web. November 20, 2011.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001747/

PubMed Health. Visual Field. Web. November 20, 2011.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004330/

Reviewed November 21, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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