Diagnosing MS: Testing and more

Doctors diagnose and monitor multiple sclerosis (MS) using a few different tests and criteria. MRI scans, blood and spinal fluid tests, and other assessments can help them rule out other causes of symptoms.
With MS, the immune system attacks myelin, which covers and protects nerve cells. During an MS exacerbation, this damage to myelin interferes with nerves’ ability to send and receive messages. Sometimes, sclerosis (scar tissue) can develop, meaning symptoms do not resolve.
For some people, treating MS can help manage the condition and slow the progression of symptoms. For this reason, it is advisable to seek a diagnosis as early as possible.
Which criteria can help diagnose MS?
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When diagnosing MS, a doctor will consider factors known as:
will consider
dissemination in space (DIS)
dissemination in time (DIT)
DIS focuses on the parts of the body that MS has affected.
For DIS, doctors will use an MRI scan to check for at least two different lesions that are characteristic of MS, or one lesion and one clinical attack affecting a different part of the central nervous system.
MRI scan
lesions
central nervous system
DIT charts MS progression over time.
MS progression
Enhancing lesions specific to MS are active lesions that exhibit severe inflammation and breaking down of the blood-brain barrier. By contrast, non-enhancing lesions in MS are chronic and do not increase in intensity.
inflammation
For DIT, a doctor will look for evidence of one of the following:
two or more clinical attacks separated by time
the presence at one time of one MRI-enhancing and one non-enhancing lesion specific to MS
one MS-specific MRI lesion at baseline and a new lesion on a follow-up MRI
specific cerebrospinal fluid (CSF) findings
cerebrospinal fluid (CSF)
Tests and diagnosis
Currently, no single test can definitively diagnose MS, and the condition can be challenging to diagnose.
A doctor will start by:
reviewing a person’s symptoms
symptoms
carrying out a physical examination
asking about personal and family medical history
They may do tests to help assess the person’s:
language functions and speech
movement, coordination, and balance
vision, smell, taste, touch, and hearing
emotional and psychological well-being
The following diagnostic tests may also help confirm the diagnosis by identifying lesions and ruling out other possible causes of symptoms.
may also help
MS can cause scar tissue, also called plaques, to develop on damaged nerves. An MRI allows a doctor to look for this scar tissue.
However, a person with these unusual lesions will not necessarily have MS. The lesions can sometimes indicate other conditions, such as migraine or high blood pressure.
migraine
high blood pressure
When a person has MS, myelin becomes inflamed, leading to injury. This injury is visible on an MRI scan.
A doctor must carefully examine an MRI scan to diagnose MS accurately.
An evoked potential test is an electrical test of the nerve pathways. It can help a doctor determine which nerve pathways have incurred damage from MS.
evoked potential test
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 sound
feeling certain sensations
Although the test is highly sensitive, it is harmless and typically painless.
Damaged myelin slows electrical conduction along nerve pathways.
A lumbar puncture enables a doctor to obtain CSF for analysis. This can help rule out other causes of symptoms.
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 atypical immune response, such as oligoclonal bands.
oligoclonal bands
Doctors no longer use lumbar puncture as a first-line test. An experienced doctor will decide whether a lumbar puncture is necessary based on a person’s medical history and the outcome of a physical examination.
Blood tests cannot diagnose MS, but they can help rule out other conditions with similar symptoms, such as:
such as
Lyme disease
Lyme disease
HIV
HIV
syphilis
syphilis
metabolic conditions that cause vitamin deficiencies
vitamin
some inflammatory and autoimmune conditions, such as sarcoidosisSjögren’s syndromesystemic lupus erythematosus
sarcoidosis
sarcoidosis
Sjögren’s syndrome
Sjögren’s syndrome
systemic lupus erythematosus
systemic lupus erythematosus
some genetic conditions, such as Fabry disease
Fabry disease
While not part of the doctor’s standard diagnostic toolkit for MS, an eye scan known as optical coherence tomography (OCT) can help pick up some early signs of the condition.
can help
OCT scanning technology uses light echoes to “see” into eye tissues, similar to how ultrasound uses sound echoes.
This kind of scan has enabled experts to gain direct images of nerves and cells in the retina. It can also show whether demyelination is due to MS or neuromyelitis optica, another cause of vision problems.
neuromyelitis optica
Early MS symptoms
Most people experience their first symptoms of MS between the ages of 20 and 40 years.
20 and 40 years
Vision changes are often among the first signs. These changes may include:
first signs
double vision
double vision
blurry vision
blurry vision
loss of vision
loss of vision
distortion between red and green
loss of color contrast
pain when moving the eye
According to the Multiple Sclerosis Foundation, a person may also notice the following:
numbness and tingling in the feet, legs, hands, arms, or face
numbness and tingling
fatigue
fatigue
difficulty walking
bladder problems
bladder problems
sexual difficulties, for example, a reduced sex drive or erectile dysfunction
erectile dysfunction
problems with memory or speech
depression and emotional changes
depression
muscle spasms and tremors
However, symptoms vary from person to person and may change over the course of the condition. Symptoms can also depend on which nerves:
are inflamed
have demyelination
incur damage
develop plaques
Anyone who suspects they may have MS should see a doctor. It is essential to seek medical help as soon as possible, as early treatment may help slow the condition’s progression.
Learn more about early signs of MS.
early signs of MS
Treatment
Treating MS typically requires a wide-ranging approach to manage the symptoms and slow the progression of the condition.
Strategies include:
include
Disease-modifying therapies: These drugs may slow MS progression and reduce the frequency and severity of relapses.
reduce
Steroid medications: These can help treat symptoms during a relapse.
Treatment for specific symptoms: A doctor may prescribe certain medications for particular symptoms, such as muscle relaxants for muscle stiffness.
Physical therapy: This can help preserve mobility and teach people how to use aids, such as a walking cane.
help preserve
Counseling: A person may benefit from counseling to help manage the effects of MS on their mental well-being.
A person will usually work with a healthcare team of different specialists.
Learn more about treating and managing MS.
treating and managing MS
Outlook
MS is a progressive condition that affects every individual who has it differently.
affects
In most cases, symptoms will come and go. Many people experience times of relapse and then periods of remission, when symptoms reduce or disappear.
Treatment aims to:
reduce the frequency and severity of attacks
manage pain, discomfort, and other symptoms during a relapse
keep the person mobile and active
preserve the person’s quality of life
The condition is not life threatening, and many people continue to live a full and active life with MS.
However, complications can sometimes arise, such as lung or bladder infections. In some cases, the condition can lead to disability and mobility issues.
can sometimes arise
Research from 2017 suggests that the life expectancy for a person with MS is around 7 years lower than for those without the condition, but this gap appears to be closing.
7 years
appears
How does MS affect life expectancy?
How does MS affect life expectancy?
Frequently asked questions
The following are answers to common questions about MS.
Early symptoms of MS include balance problems, difficulty walking, fatigue, and blurred vision.
Yes, MS can be difficult to diagnose. This is because no single test can diagnose the condition. A doctor will review a person’s symptoms, carry out a physical exam, and order tests.
Doctors most commonly diagnose MS when a person is between the ages of 20 and 40 years.
20 and 40 years
Yes, signs of MS can show up on an MRI. The condition causes inflammation or scar tissue to develop on damaged nerves, and the presence of scar tissue in an MRI scan means a person might have MS.
Visit our dedicated hub for more research-backed information and in-depth resources on multiple sclerosis (MS).
multiple sclerosis (MS)
Summary
There is no specific test to diagnose multiple sclerosis (MS). Instead, doctors will consider various factors, such as the number and types of attacks of symptoms a person has had, any lesions that show up on an MRI scan, and the results of other tests to rule out other conditions.
If a doctor diagnoses MS, they may recommend long-term treatment with disease-modifying therapies, which can help reduce the frequency and severity of relapses.