Diagnosing Multiple Sclerosis – What Makes It So Difficult?

Know the signs and symptoms your doctor will look for in examining you for multiple sclerosis.

Diagnosing Multiple Sclerosis - What Makes It So Difficult?

Besides the fact that no single test can detect the disease, MS symptoms can mimic those of a number of other conditions, and they can change over time. Symptoms can also vary from person to person — and from day to day in the same person.

Here’s what you should know.

Symptoms of Multiple Sclerosis

Some early symptoms of MS are:

  • Numbness or tingling in parts of the body, usually an arm or leg
  • Unexplained weakness, dizziness and fatigue
  • Blurry vision, double vision or blindness

Other symptoms include:

  • Muscle spasms
  • Impairment of the sense of touch and the ability to feel temperature changes and pain
  • Problems with balance and coordination
  • Tremor
  • Slurred speech
  • Bladder and bowel problems
  • Sexual problems
  • Depression
  • Mild difficulties with concentration, attention, memory and poor judgment
  • Moderate to severe pain
  • Heat sensitivity

To diagnose the disease, healthcare providers use a number of tools and tests that often help rule out other possible causes.

Multiple Sclerosis Diagnosis: Tools and Tests

  • Medical history: Doctors ask for details about personal health history and family health history and also question patients carefully about symptoms, their duration and their onset.
  • Physical examination: A physical exam will most likely include tests to determine the health of nerves and muscles. Doctors may look for weakness in specific parts of the body, uncoordinated eye movements, and problems with balance, vision, and speech.
  • Magnetic resonance imaging (MRI): If doctors possibly suspect MS after a physical exam, they will probably order additional diagnostic tests, starting with an MRI. During an MRI, a patient’s body is placed within a magnetic field and scanned by radio waves. This combination creates detailed pictures of the part of the body being examined. In MS, doctors take scans of the brain or spine depending on the symptoms and physical exam. The resulting pictures can show patches, or scars, in the central nervous system where myelin has been destroyed. These areas are referred to as plaques. Since other disorders can cause these patches, an MRI scan can’t provide definitive evidence of multiple sclerosis. But doctors rely primarily on MRIs to see evidence of the disease. MRIs are also important in tracking the progress of the disease, and doctors may order new tests from time to time to monitor a patient’s condition. Researchers also use the test to see if experimental treatmentshave an effect on scarring in the central nervous system.
  • Cerebrospinal fluid collection (CSF collection): If the diagnosis is still not clear, doctors may take a sample of spinal fluid. Patients typically lie on their sides with their knees bent up. The doctor administers a local anesthetic in the lower spine and, using another needle, takes out a sample of the spinal fluid. Doctors examine the sample for abnormalities associated with MS, such as increases in white blood cells and high levels of an antibody called immunoglobulin G.
  • Evoked response tests (ERTs): These electronic tests, sometimes called evoked potential tests, measure the speed of brain connections. The most common ERTs are the visual evoked response test (VER), the brainstem auditory evoked response test (BAER) and the sensory evoked response test (SER). In each, doctors attach wires to a patient’s scalp. Then, depending on the test, they give patients visual, auditory, or sensory stimulation. These stimuli are a checkerboard pattern patients see on a monitor, a series of clicks they hear through earphones, or short electrical impulses they feel on an arm or leg. The tests measure the speed of visual, hearing, and sensory pathways and can detect damaged areas in the brain.

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