How Do Doctors Diagnose Multiple Sclerosis?
Multiple sclerosis occurs when a person’s immune system is triggered to attack the myelin sheath—a protective coating surrounding nerve cells in the central nervous system (CNS). The CNS is made up of the brain and spinal cord and acts as the control center of the body. Over time, repeated attacks on the myelin sheath and the nerve cells wrapped around it disrupt communication between the CNS and the rest of the body.
Without the proper intervention, damage to the myelin sheath can irreversibly stop a specific body part from functioning properly. But to get treatment, doctors must first make a diagnosis for multiple sclerosis.
Diagnosing multiple sclerosis comes with its own set of challenges. To start, multiple sclerosis affects everyone differently, as nerve damage causes a wide variety of symptoms. There is also no official test to diagnose multiple sclerosis. Instead, doctors use blood tests to rule out other conditions and several techniques to confirm the symptoms are consistent with multiple sclerosis.
When diagnosed in time, multiple sclerosis is treatable. You can live a normal life with multiple sclerosis. Benjamin Greenberg, M.D., an autoimmune disorders expert at UT Southwestern Medical Center, says that neurologists are still wrestling with whether they have a cure for multiple sclerosis. There are many different therapeutic options, and he’s seen patients go decades with no evidence of any disease. “You can’t even tell they have multiple sclerosis,” he adds. “It’s possible to have an excellent quality of life, and we can probably keep patients in remission and prevent them from relapsing.”
You might feel terrified to receive a multiple sclerosis diagnosis. But it’s the first step towards getting the help your body needs to work at full capacity.
Symptoms of multiple sclerosis
J. William Lindsey, M.D., director of multiple sclerosis at UTHealth Houston and neurologist at Memorial Hermann, says the first thing doctors do is to perform a clinical assessment. A clinical check-up would take in a person’s medical history, collect information on the patient’s family history of multiple sclerosis, and observe for neurological symptoms consistent with multiple sclerosis. Your medical provider will also take note if the symptoms have appeared before and for how long, or if this was an isolated event.
Multiple sclerosis has a range of symptoms, and no two cases may look exactly alike. Jeffrey Kane, M.D., a pediatric neurologist at Pediatrix Child Neurology Consultants of Austin, says that for this reason, multiple sclerosis specialists search for any sign of a ‘focal neurologic deficit.’ In other words, a set of symptoms in a specific location that relates to the spinal cord or brain function. “You might lose strength in one arm, or you might lose vision in one eye,” he explains.
Some of the most common multiple sclerosis symptoms doctors look for include:
Muscle weakness or numbness, usually on one side of the body
Vision loss
Complaints of bladder problems
Issues with walking or moving around
Fatigue
What tests do doctors perform to diagnose MS?
MRI scans
Lindsey says the most helpful diagnostic tool for multiple sclerosis is using an MRI to look at a patient’s central nervous system. MRI scans allow doctors to identify any lesions in the brain and the spinal cord that would suggest damage related to multiple sclerosis. “Even if somebody is presenting with their first ever symptom, they frequently will have already have multiple lesions in the brain.”
Spinal tap/lumbar puncture
A spinal tap, also known as a lumbar puncture, is a medical procedure where a doctor will insert a needle into your lower back to take a sample of cerebrospinal fluid, the fluid that protects your brain and spinal cord from injury. The sample is then analyzed for abnormal proteins and high levels of white blood cells that would indicate the immune system is fighting. The spinal fluid sample is also tested to look for specific markers linked to multiple sclerosis.
Vision test
Any part of the nervous system is vulnerable to the effects of multiple sclerosis, but some parts are affected more often than others. Lindsey says that about 25% of people who go on to develop multiple sclerosis first present with optic neuritis. Optic neuritis is when damage to the optic nerve causes vision loss in one eye, resulting in either loss of vision or blurred vision.
What happens if you delay getting a diagnosis?
All experts agree it is essential to see your medical provider if you suspect your symptoms are related to multiple sclerosis. Lindsey says the past 30 years have seen more preventative medications available to decrease the number of multiple sclerosis relapses and slow down the disease progression.
The earlier you get your diagnosis, the better. “The biggest we can have as physicians is to get people with [multiple sclerosis] started on treatment right after their MS diagnosis or right after they present with their first symptoms,” advises Lindsey. “The most effective ones we’ve seen have reduced the number of new symptoms by about two-thirds and make a big difference in long-term outcome and disability.”
But you can’t start therapy until you're diagnosed. Research suggests a delay in diagnosis impacts how the treatment responds to your body. “We've looked at patients who had a delay of therapy of one or two years and then after 10 years later, and they're doing worse than patients who were treated immediately,” explains Dr. Greenberg.
One of the reasons why a delay in diagnosis is significant is because treatments are preventative. They cannot reverse the damage already done from previous attacks. Kane explains that “you can have a disability from the attacks you’ve already had, and now you just have to live with it.”
Treatments are available immediately after diagnosis
The overall goal of treatment is to manage multiple sclerosis symptoms and slow down disease progression. Greenberg says the first half involves immediate action to stop a multiple sclerosis attack. A person may be prescribed corticosteroids to relieve nerve inflammation.
If your symptoms are new, your doctor may conduct a blood-cleansing procedure called plasma exchange. The method involves removing the plasma from the blood to remove antibodies and other proinflammatory markers before putting it back in the body. Other efforts involve treating the individual symptoms. “If somebody presented with vision loss on their right, they usually need high dose steroids to help restore vision and prevent further damage.”
After calming down the attack, doctors focus on preventing future relapses. The US Food and Drug Administration has approved a long list of multiple sclerosis drugs that are available through injections, infusions, or by mouth. Medications can also be prescribed to manage recurring symptoms such as depression or tremors. “It’s just a matter of picking the right drug for the right person and getting them started on it, which is why we want the diagnosis to happen as soon as possible because there is something we can do about multiple sclerosis,” says Greenberg.
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