Diagnosis of Multiple Sclerosis

Multiple sclerosis is a debilitating disease that is noncontagious.  It is a chronic autoimmune disorder of the central nervous system. Multiple sclerosis can present with a variety of neurological symptoms that will either occur at the time of an attack or slowly progress over time.  As of yet there is no known cure and the exact cause remains unknown.

Multiple sclerosis is often characterized by recurring neurological episodes that are due to lesions in different locations in the nervous system.  It\’s important to make an initial diagnosis as early as possible in order to slow the progression of the disease.  Current statistics tell us that approximately 30% of individuals who seek medical care after the first initial inflammatory event will develop progressive multiple sclerosis within the year.  Unfortunately, at this time, doctors can not predict who will be at the highest risk for disease that is rapidly progressing.

Many of the signs and symptoms of multiple sclerosis can be attributed to a number of different conditions.  At this time there is neither a sign, symptom nor test that will unconditionally prove multiple sclerosis.  Diagnosis of multiple sclerosis can be done quickly if there is clearly an abnormal neurological examination with some of the more classic symptoms.

One of those symptoms is inflammation of the optic nerve, and the nerves behind the eye.  This is called retro bulbar neuritis and results in a rapid loss in vision acuity, decreased perception of color and decreased central vision field loss.  Optic neuritis often includes pain with eye movement and episodes will reappear, reaching a peak within days.

Optic neuritis is often invisible and symptoms are either not noticed or simply dismissed. Fortunately, testing using visual evoked potential responses (VER) will show damage even after the symptoms of optic neuritis has disappeared.  This helps physicians to consider a diagnosis of multiple sclerosis.

The second symptom which is characteristic of multiple sclerosis is paraparesis. This is a weakness, but not total paralysis, of the lower extremities.  This means that the neurological changes in the spinal cord have affected the strength in the lower extremity innervation to the legs.

Individuals with multiple sclerosis will also suffer from other symptoms which include depression, dizziness, fatigue, heat sensitivity, numbness, tingling or pain in the lower extremities, urinary bladder dysfunction or visual impairment.  Other signs include action tremors, decreased strength, impaired coordination and balance, nystagmus and decreased perception of pain, vibration or position.

Once multiple sclerosis has been diagnosed the pattern of the disease is uncertain.  Physicians and researchers are unable to predict which patients will have a more aggressive disease.  Multiple sclerosis can be very benign or can rapidly progress and become severe.  While magnetic resonance imaging is able to detect lesions on the brain it is not able to predict the ultimate function of the patient.

The severity of the disease does not appear to be related to the number of lesions in the brain or spinal cord, the rate of their appearance or their location.  At this time research is continuing to identify biological markers or possibly certain antibodies that will help to determine and accurate onset in severity as well as prognosis, once diagnosis has been made.

RESOURCES

National Multiple Sclerosis Society: Diagnosing MS

Multiple Sclerosis Foundation: How is Multiple sclerosis diagnosed

MayoClinic: Multiple Sclerosis

Lancet Neurology: MRI and the Diagnosis of Multiple Sclerosis

Archives of Neurology: Clinical diagnosis of Multiple Sclerosis

Advances in Neurology: The Role of MRI in the Diagnosis of Multiple Sclerosis

Journal of Neurology, Neurosurgery and Psychiatry: Making the diagnosis of Mulitple Sclerosis

Mulitple Sclerosis Society: Diagnosis