How is multiple sclerosis diagnosed?
There is no single test that confirms the diagnosis of multiple sclerosis, and there are a number of other diseases with similar symptoms. While one person's diagnosis may be immediately suggested by her symptoms and history, another's may not be confirmed without multiple tests and prolonged observation. The distribution of symptoms is important: multiple sclerosis affects multiple areas of the body over time. The pattern of symptoms is also critical, especially
evidence of the relapsing- remitting pattern, so a detailed medical history is one of the most important parts of the diagnostic process. A thorough search to exclude other causes of a patient's symptoms is especially important if the following features are present: 1) family history of neurologic disease, 2) symptoms and findings attributable to a single anatomic location, 3) persistent back pain, 4) age of onset over 60 or under 15 years of age, or 5) progressively worsening disease.
A definite diagnosis of multiple sclerosis requires evidence for dissemination of lesions within the central nervous system both in space and in time. This means that not only must there exist evidence of at least two distinct lesions, verifiable by clinical symptoms or by Magnetic Resonance Imaging (MRI), there must also be evidence of an occurrence of new symptoms or lesions within a time interval of at least 30 days. A lumbar puncture, which is a procedure done to collect a sample of cerebrospinal fluid, is useful for providing evidence of chronic inflammation of the central nervous system, often indicated by oligoclonal banding. Nerve conduction studies of optic, sensory and motor nerves can provide further evidence for multiple sclerosis, as the process of demyelination results in reduced nerve conduction velocities. The diagnostic process is completed by several laboratory tests to exclude other diseases that can mimic multiple sclerosis, such as sarcoidosis, vasculitis, and Lyme disease.
Magnetic resonance imaging (MRI) can reveal plaques on the brain and spinal cord. Gadolinium enhancement can distinguish between old and new plaques, allowing a correlation of new plaques withnew symptoms. Plaques may be seen in several otherdiseases as well, including encephalomyelitis, neurosarcoidosis, and cerebral lupus. Plaques on MRI may be difficult to distinguish from small strokes, areas of decreased blood flow, or changes seen with trauma or normal aging. A lumbar puncture, or spinal tap, is done to measure levels of immune proteins, which are usually elevated in the cerebrospinal fluid of a person with multiple sclerosis. This test may not be necessary if other tests are diagnostic. Evoked potential tests, electrical tests of conduction speed in the nerves, can reveal reduced speeds consistent with the damage caused by plaques. These tests may be done with small electrical charges applied to the skin (somatosensory evoked potential), with light patterns flashed on the eyes (visual evoked potential), or with sounds presented to the ears (auditory evoked potential).
The clinician making the diagnosis, usually a neurologist, may classify the disease as "definite multiple sclerosis," meaning the symptoms and test results all point toward multiple sclerosis as the cause. "Probable multiple sclerosis" and "possible multiple sclerosis" reflect less certainty and may require more time to pass to observe the progression of the disease and the distribution of symptoms.
More information on multiple sclerosis
What is multiple sclerosis? - Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by the hardening of patches of tissue in the brain and spinal cord.
What causes multiple sclerosis? - Multiple sclerosis is caused by an unknown agent that gradually destroys the myelin covering, or sheath, of nerve fibers, resulting in a temporary interruption.
Is multiple sclerosis inherited? - Multiple sclerosis is a typical complex trait and susceptibility is genetically determined. People with MS inherit certain regions on individual chromosomes more often than people without MS.
What's the typical course of multiple sclerosis? - Multiple sclerosis is recognized as occurring with seven different patterns. Multiple sclerosis starts with an acute flare-up of symptoms within hours to days.
Who is at the risk of multiple sclerosis? - Multiple sclerosis affects women almost twice as frequently as men. Climate, diet, geomagnetism, toxins, sunlight, genetic factors, and infectious diseases are risk factors for multiple sclerosis.
What types of multiple sclerosis are there? - Multiple sclerosis have different patterns including relapsing/remitting multiple sclerosis, secondary progressive multiple sclerosis, progressive relapsing multiple sclerosis.
What're the signs and symptoms of multiple sclerosis? - The first symptoms of multiple sclerosis are often visual changes. Later symptoms may include fatigue, muscle spasticity and stiffness, tremors, paralysis, pain.
How is multiple sclerosis diagnosed? - A definite diagnosis of multiple sclerosis requires evidence for dissemination of lesions within the central nervous system both in space and in time.
What's the treatment for multiple sclerosis? - The treatment of multiple sclerosis aims at decreasing the rate and severity of relapse, reducing the number of lesions, delaying the progression of the disease.
What's prognosis of multiple sclerosis? - Most people with multiple sclerosis will be able to continue to walk and function at their work for many years after their diagnosis.
Dietary therapy for multiple sclerosis - The main role of diet in multiple sclerosis is to enable people to manage common problems which include fatigue, incontinence and constipation.
Nutritional supplements for multiple sclerosis - Nutritional therapy is used for alleviating the symptoms of multiple sclerosis or altering the natural course of the disease.
Does multiple sclerosis affect pregnancy? - Multiple sclerosis has no adverse effects on the course of pregnancy, labor, or delivery. Pregnancy doesn't affect the long term course of the disease.
Can vitamin D reduce multiple sclerosis risk? - Vitamin D supplements may positively influence the immune systems of patients with multiple sclerosis. Vitamin D has a beneficial influence on ongoing multiple sclerosis.