Multiple sclerosis diagnosis
Multiple sclerosis (MS) can present different symptoms in different people at different times and the process of diagnosis can be a lengthy one for some.
Some symptoms such as mobility changes are more obvious, but some are not, for example, fatigue or sensory disturbances. There is no set pattern and some people will experience symptoms that others will not and these can also vary from time to time, occurring singly or in combination.
Some people have mild symptoms, while others have problems that are moderate or severe, taking the form of episodes or ‘relapses’ (a temporary worsening of symptoms). Other people experience a slow, sometimes almost imperceptible change in their physical condition with no obvious episodes.
Unfortunately, there is no single test or procedure that can be used to diagnose MS. It is often a case of watching and waiting to see if new symptoms appear or previous symptoms recur. This process can be frustrating; it is hard to accept that a conclusive diagnosis can take months, or years.
Diagnosis is based on a number of things such as looking into medical history, neurological examinations and a series of tests. Other conditions need to be ruled out before a diagnosis can be confirmed.
Only a neurologist can make the diagnosis of MS. A neurologist will perform other tests to ensure that symptoms are consistent with an inflammatory process in the body and that all other alternative diagnoses have been excluded.
The process starts with a neurological examination during which your full medical history will be taken into account. Collecting your history is important as prior symptoms such as visual disturbances or numbness may have been treated or passed by without the consideration of MS at the time. The neurologist will then perform simple tests to check movement, coordination, balance, reflexes and other sensory tests. The neurologist performs these tests to establish whether there are signs of the inflammatory process in the body.
If your medical history and neurological examination suggest MS, more tests will be conducted to look for further evidence in your body. The neurologist will be looking for ‘lesions’ on the brain or spinal cord. These lesions occur when the inflammation process has left scarring on the fatty myelin sheath that surrounds the nerve. A neurologist will need to establish that lesions have developed at different times, and in different areas of the body for a diagnosis of MS.
The neurologist will make a diagnosis of MS based on established criteria, such as the revised 2010 McDonald criteria (2). The McDonald Criteria are used to seek to establish evidence of damage to the central nervous system (CNS) comprising of the brain and spinal cord. The McDonald criteria is available to download below. In summary, a diagnosis of MS is undertaken through a combination of your medical history, clinical and neurological assessment and judgment by a neurologist.