Diagnosis

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Diagnosing MS involves several tests and a lot of discussions with several types of health care professionals. You can expect a complete physical examination, a discussion of your medical history and a review of your past and/or current symptoms.

You should pay attention to any symptom suggestive of MS. Early diagnosis of MS is important because a new generation of treatments introduced in the 1990s can reduce the frequency and severity of MS attacks. In fact, research has prompted health care professionals to change the diagnostic criteria to treat more cases of MS as early as possible.

The long-established criteria for diagnosing MS requires that the patient experience two separate "attacks"—symptoms suggestive of neurological damage, such as blurry vision, numbness, tremors or difficulty with balance. The two attacks had to be different in type and separated in time, suggesting damage to two areas of the central nervous system. The delay between a first and second attack meant that a conclusive diagnosis could take years.

Today, health care professionals use magnetic resonance imaging (MRI) to scan the brain for lesions indicating early evidence of damage, in addition to other tests. An MRI is painless and noninvasive. If you need one, a health care professional will have you lie on your back on a table. The table will be pushed into a tube-like structure and detailed pictures of your brain and, sometimes, spinal cord will be taken. These images are able to show scarred areas of the brain.

Despite these results, some neurologists have continued to favor the old standard of two kinds of attacks separated in time. The controversy led to the convening of an international panel of experts, whose recommendations were published in the April 2, 2001, issue of the Annals of Neurology. The recommended criteria allow for diagnosis of MS based on one clinical attack and evidence of lesions on an MRI performed at least three months after the attack, cerebrospinal fluid analysis and visual evoked potentials to provide evidence of the second attack and thereby confirm the diagnosis more quickly. The International Panel then reconvened in March 2005 to consider extensive research that had been collected since 2001 and to recommend appropriate revisions to the criteria. These revisions, termed the 2005 Revisions to the McDonald Diagnostic Criteria for MS, were published in the Annals of Neurology 2005. They will help to enhance the speed and accuracy of an MS diagnosis. Yet, the clinical standard remains the backbone of diagnosis and continues in force in some clinics.

Bear in mind that a normal MRI does not ensure that a person does not have MS. About five percent of MS patients have normal MRIs, according to the National Multiple Sclerosis Society. Other diagnostic tests may be recommended to establish an MS diagnosis. These include:

• Visual evoked potential tests, which measure how quickly a person's nervous system responds to certain stimulation. These tests offer evidence of neurological scarring outside the brain. Evoked potential tests are painless and noninvasive. A health care professional or technician will place small electrodes on your head to monitor your brain waves and your response to auditory, visual and/or sensory stimuli. The time it takes for your brain to receive and interpret messages is a clue to your condition.

• A spinal tap, which tests cerebrospinal fluid (fluid surrounding the brain and spinal cord) for substances that indicate strong immune activity in the central nervous system. If you have this test, you will likely be given an injection of local anesthesia. You may experience a headache and nausea following the test.

• Blood tests, to rule out other potential causes of symptoms, such as Lyme disease and AIDS.

If you are diagnosed with MS, it will almost certainly be one of four types:

Relapsing-remitting MS: This is the most common form of the disease at the time of diagnosis, affecting 85 percent of patients at this stage. People with this type of MS experience clearly defined exacerbations or relapses, followed by partial or complete remissions (or recovery periods) where the disease stops progressing.

Secondary progressive MS: According to the National Multiple Sclerosis Society, before the introduction of disease-modifying drugs, about half of individuals with relapsing-remitting MS experienced a gradual worsening of symptoms with or without occasional flare-ups, minor remissions or plateaus within 10 years of initial diagnosis. This form of MS is called secondary progressive MS. At this point, the long-term data are not available to determine whether or not the changeover in diagnosis from relapsing-remitting to secondary progressive MS is delayed by treatment.

Primary progressive MS: This type of MS is characterized from the onset by a nearly continuous worsening of the disease, with no distinct relapses or remissions. There may be temporary plateaus with minor relief from symptoms but no long-lasting relief. About 10 percent of people with MS have primary progressive MS.

Progressive-relapsing MS: This form of the disease is relatively rare and takes a progressive course from the onset but also is characterized by obvious acute attacks, with or without recovery. In contrast to relapsing-remitting MS, the periods between relapses are characterized by continuing disease progression. About five percent of people with MS have progressive-relapsing MS.

MS varies so greatly in each individual that it is hard to predict the course the disease might take. However, some studies show that people who have few attacks in the first five years following a positive diagnosis of MS, long intervals between attacks, complete recoveries and attacks that are sensory only in nature generally have a less debilitating form of the disease.

On the other hand, people who have early symptoms that include tremors, lack of coordination or frequent attacks with incomplete recoveries generally have a more progressive form of MS. These early symptoms indicate that more myelin (the fatty insulation surrounding nerve cells in the brain and spinal cord) has been damaged.

Since MS generally strikes a woman during childbearing years, many women with the disease wonder if they should have a baby. Studies show that MS has no adverse effects on the course of pregnancy, labor or delivery; in fact, symptoms often stabilize during pregnancy. Although MS poses no significant risks to a fetus, physical limitations of the mother may make caring for a child more difficult. Also, women with MS who are considering having a child should discuss with their health care professionals which drugs to avoid during pregnancy and while breastfeeding. The disease-modifying drugs are not recommended during breastfeeding because it isn't known if they are excreted in breast milk.