Friends With RSD/Chronic Pain And Illnesses

Diagnosing MS

There is no single test that is proof-positive for diagnosing multiple sclerosis. However, there are accepted criteria for making the diagnosis, but even this system is imperfect.

Since diagnosing MS can be very difficult, a neurologist who specializes in treating MS should evaluate your symptoms. As many as 10% of people diagnosed with multiple sclerosis actually have some other condition that mimics MS. Examples of other conditions that masquerade as MS include inflammation in the blood vessels, multiple strokes, vitamin deficiency, lupus, or brain infection. Sometimes stress-related disorders can lead to a misdiagnosis of MS.

How Is the Diagnosis Made?

An accurate diagnosis is based on your medical history and a neurological examination (examination of the function of the brain and spinal cord) using various tests. A lot depends on the skill of the doctor in asking the right questions to uncover information and to properly evaluate the signs and symptoms of a malfunctioning brain or spinal cord.

In addition to a thorough medical history and examination, a variety of specialized procedures are helpful -- although not always necessary -- to accurately diagnose MS. These include imaging techniques, such as MRI, spinal taps or lumbar punctures (examination of the cerebrospinal fluid that runs through the spinal column), evoked potentials (electrical tests to help determine if MS has affected a person's nerve pathways), and laboratory analysis of blood samples.

What Are the Accepted Criteria for Diagnosis?

Onset usually occurs between 20 and 50 years of age
Symptoms and signs indicating disease of the brain or spinal cord
Evidence of two or more lesions upon examination by MRI scan
Objective evidence of disease of the brain or spinal cord on doctor's examination
Two or more episodes lasting at least 24 hours and occurring at least one month apart
No other explanation for the symptoms

What Does an MRI Show?

MRI is the best test to view the changes caused by MS. The precise image produced by MRI gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS.

However, abnormal spots on the brain MRI can be caused by other conditions, so before making a diagnosis your doctor will consider all information including your symptoms and scan results. Similar lesions can be seen in elderly people or people with migraine headaches or high blood pressure.

Also, a normal MRI does not absolutely rule out a diagnosis of MS. About 5% of patients who are confirmed to have MS on the basis of other criteria, do not have lesions in the brain on MRI. These people may have lesions in the spinal cord or may have lesions that cannot be detected by MRI.

Will I Need a Spinal Tap (Lumbar Puncture)?

Performing a spinal tap to examine the cerebrospinal fluid may be helpful in diagnosing MS in some people, but it is no longer considered necessary in all instances.

Experienced specialists will be able to determine if you need this test to confirm a suspected diagnosis of MS, particularly if your history and examination suggest the presence of the disease. Abnormalities that may appear in the cerebrospinal fluid can be very helpful in establishing a diagnosis but, like other tests, spinal taps are not foolproof in diagnosing MS.

What Other Tests Are Given?

Electrical tests of the nerve pathways, known as evoked potentials, are very helpful in confirming whether MS has affected the visual, auditory, or sensory pathways. These tests are done by placing wires on the scalp to test the brain's response to certain types of stimulation, such as watching a pattern on a video screen, hearing a series of clicks, or receiving electrical impulses in your arm or leg.

Your doctor may order a blood test to help rule out conditions that mimic (imitate) multiple sclerosis, but the presence of MS cannot be detected in the blood.

Accepting the Diagnosis

The diagnosis of multiple sclerosis can be a lengthy process. Upon hearing the diagnosis, you may feel a mixture of emotions, including denial, fear, relief, optimism, or hope. For some people, a diagnosis after months or years of symptoms is a relief, but for others it may be shocking. Even when a diagnosis of MS is made, the uncertainty is not over. You may have some concerns about the unknown elements of the disease, its course and its impact. This is completely understandable. The course of MS is unpredictable; not knowing how the disease will affect you over the long term is probably the most difficult factor to deal with. Sharing your thoughts and emotions with others can help you cope with the diagnosis. Remember that MS affects everyone differently so what one person with MS experiences may not be what you will experience. To learn more about coping with a diagnosis of MS, visit Living With MS.

Reviewed by the doctors at the Mellen Center for Multiple Sclerosis Research at The Cleveland Clinic.

Reviewed by Brunilda Nazario, MD on November 01, 2006

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