Early MS may present itself as a history of vague symptoms which may
have subsided and many of the signs could be attributed to a number of
medical conditions. Therefore, a period of time may elapse and a prolonged
diagnostic process may be involved before MS is suggested. On the other
hand, a possible diagnosis of MS may be more clear-cut with classic
symptoms (e.g. optic neuritis) and a distinct chronology of attacks. The
neurologist requires evidence that the types of neurological deficits indicate
involvement of at least two different areas of the central nervous system
with effects occurring at two separate times.
Multiple Sclerosis is essentially a clinical diagnosis and there are no tests
which are specific for the condition and no single test is 100% conclusive.
Therefore several tests and procedures are needed to establish a diagnosis
of MS and they include the following investigations:
Medical History
The physician will ask for a medical history which will include your past
record of signs and symptoms as well as the current status of your health.
The type of symptoms, their onset and pattern may suggest MS, but a full
physical examination and medical tests will be needed to confirm the
diagnosis.
Neurological Examination
The neurologist is testing for abnormalities in nerve pathways. Some of the
more common neurologic signs involve changes in eye movements, limb
co-ordination, weakness, balance, sensation, speech, and reflexes.
However, this examination cannot conclude what is causing the
abnormality and so other possible causes of illness which produce similar
symptoms to MS must be eliminated.
Testing of Visual and Auditory Evoked Potentials
When demyelination (scarring) occurs the conduction of messages along
the nerves may be slowed. Evoked potentials measure the time taken for the
brain to receive and intepret messages (nerve conduction velocity). This is
done by placing small electrodes on the head which monitor brain waves in
response to visual and auditory (hearing) stimuli. Normally, the brain's
reaction to such stimuli is almost instantaneous, but if there is demyelination
in the central nervous system a delay may occur. This test is not invasive or
painful and therefore does not require a stay in hospital.
Magnetic Resonance Imaging (MRI)
The MRI scanner is a more recent diagnostic test and takes very detailed
pictures of the brain and spinal cord, showing any existing areas of sclerosis
(lesions or plaques). Whilst this is the only test in which the lesions of
Multiple Sclerosis can be seen, it cannot be regarded as conclusive,
particularly as not all lesions may be picked up by the scanner and because
many other conditions can produce identical abnormalities. The MRI
clearly shows the size, quantity and distribution of lesions, and together with
supporting evidence from medical history and neurologic examination, is
very significant indicator toward confirming the diagnosis of MS
The MRI is also a very useful tool in clinical trials in assessing the value of
new therapies by its ability to measure disease activity in the brain and
spinal cord.
Lumbar Puncture (Spinal Tap)
In this test, cerebrospinal fluid (the fluid which flows around the brain and
spinal cord) is tested for the presence of antibodies. Antibodies can occur
with MS but they can also occur with other neurological conditions. The
fluid is taken from the spinal cord by inserting a needle into the back and
withdrawing a small amount of fluid. A local anaesthetic is given to numb
the skin, and therefore while it is uncomfortable it is not usually painful.Although mine was a killer.
This test does require the person to lay flat for a number of hours after the
test, and may require an overnight stay in hospital. Subsequently for some,
a short period of recuperation may be required.
