Here’s how docs know for sure whether or not you have MS.
When a person goes to the doctor to get a symptom (say, tingly hands) evaluated, most aren’t thinking they have multiple sclerosis. “They’re thinking they have an infection or some other mild medical complaint, and then a diagnosis of MS takes them by surprise,” says Michelle Fabian, MD, a neurologist at The Mount Sinai Hospital in New York City.
MS is a nervous system disease that affects your brain and spinal cord. It’s an autoimmune disease in which the body’s immune system damages the myelin sheath, the material that surrounds and protects nerve cells. This damage slows down or blocks messages between your brain and your body, which can causing a wide range of debilitating symptoms, like weakness, blurry vision, and trouble balancing.
An MS Diagnosis: What Doctors Are Looking For
To diagnose MS, doctors first perform exams and tests to rule out other causes of the patient’s symptoms, and then use several strategies to determine if their symptoms fit the criteria for MS.
If a primary care doctor suspects MS, they’ll refer them to a neurologist. The neurologist will listen to the patient’s story, and then begin to seek out the source of their symptoms. “What they’re looking for in the exam, is whether we can relate the symptom to a problem in the central nervous system, the brain or the spinal cord, or the peripheral nervous system, which are the nerves that connect the brain to the spinal cord,” says Dr. Fabian.
Tools for Making an MS Diagnosis
The neurologist will perform a neurological exam, carefully examine the patient’s medical history, and conduct various tests, which may include:
- blood tests to rule out other possible conditions
- magnetic resonance imaging (MRI) to look for MS lesions
- evoked potentials (EP) to measure electrical activity in the brain
- a spinal fluid analysis to look for a marker in their spinal fluid
An Early MS Diagnosis is Key
If you’re feeling any symptoms that are unusual to you, like numbness, difficulty walking, dizziness, or cognitive changes, always check with your doctor. “We do want to get a patient on treatment sooner rather than later,” says Dr. Fabian. Many studies show that the earlier the treatment for MS, the better that patient will do in the long run.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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MS can be misdiagnosed, especially in
the beginning when the symptoms are mild.
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A patient may come in with something
like a numbness in the hand, and
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a doctor chalks it up to carpal
tunnel syndrome or something similar.
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Say a patient has
a numbness in their hand.
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They might go to their primary doctor, and
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their primary doctor refers
them to the neurologist.
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The neurologist will listen to the story,
and they will do an examination.
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And what they're looking for
in the exam is whether we can relate
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this symptom to a problem in
the central nervous system.
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The brain or the spinal chord, or
the peripheral nervous system,
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which are the nerves that connect
to the brain and the spinal chord.
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And we do have different techniques
that we can use to try to sort that out.
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We do usually get a panel of blood tests.
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We do wanna make sure we of course
have the accurate diagnosis of MS and
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not another condition where
there's a blood test.
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We don't have a blood test that
it can help us diagnose MS.
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So we're really doing those tests just
to make sure there's nothing else.
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And we usually get MRI of the brain or
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spinal cord which includes the cervical
spinal cord and the thoracic spinal cord.
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So sometimes this is
like three separate MRIs.
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And then some patients also get what
we call lumbar puncture or spinal tap.
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And that we do because 90% of the time,
patients with MS
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have marker in their spinal fluid
that supports the diagnosis of MS.
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But that means 10% of
the time people have MS,
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and they don't have that
marker in the spinal fluid.
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So we don't do a spinal tap on everyone.
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In a neurological exam, what we're
doing is trying with pretty simple
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exam maneuvers to test what we can
on the central nervous system.
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So we are assessing
the patient's cognition.
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We are looking at their visual system.
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We are thinking about their strength and
their motor system.
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We're testing their sensory system,
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And also, we are testing their walking.
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When we diagnosis a patient with MS,
we have this thing,
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it's called dissemination in time and
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It's a little bit of
a tricky topic I think, but
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what we want to prove using
dissemination in time and space is that,
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a patient has had evidence
of this immune attack,
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in multiple places in the central nervous
system, that's dissemination in space.
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And then at multiple time points.
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So that's dissemination in time.
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The reason we use those criteria, because
we wanna make sure we're diagnosing MS and
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that we're not mistaking it for
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And so MS is really one of the only
conditions out there where we have both of
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Multiple points in the nervous system,
multiple points in time.
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Most people I find actually don't think
of MS when they have their symptom and
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they go into the primary care doctor.
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They're thinking it could be
that they have a infection or
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some other mild medical complaint and then
a diagnosis of MS takes them by surprise.
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We do have a of of studies that show
that if we treat somebody earlier,
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they do better in the long run.
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And so we do want to get a patient on
treatment sooner rather than later.
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Multiple sclerosis. Bethesda, MD. U.S. National Library of Medicine, MedlinePlus. (Accessed on April 1, 2021 at https://medlineplus.gov/multiplesclerosis.html)Diagnosing MS. New York, NY. National Multiple Sclerosis Society. (Accessed on April 1, 20218 at https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-MS)