How Is Multiple Sclerosis Diagnosed?
There's no single test that can tell whether you have multiple sclerosis (MS), so it may take some time and multiple doctor visits to get a diagnosis. Doctors use a combination of physical exams, medical history questions, imaging tests, and laboratory tests to diagnose the condition.
The symptoms of MS are similar to those of several other health conditions, so your doctor will need to rule those out.
MS Diagnosis
Your doctor may suspect you have MS if you have symptoms like:
- Numbness or tingling in your skin (usually in your hands or feet)
- Unusual weakness in your arms, legs, or fingers
- Slurred speech
- Stumbling or trouble walking
- Double vision or loss of color
- Flashing lights that others can't see
- Eye pain that gets worse when you move
When you first notice these symptoms, especially if they're serious, your doctor will rule out other possible causes like stroke, tumor, or pressure on the spinal cord. If the symptoms last more than a couple of days, your doctor may refer you to a neurologist (a brain and nervous system specialist) for a diagnosis.
The neurologist will ask you questions about what symptoms you've had, how long they've lasted, and whether you've ever had them before. They'll do a physical exam to check your:
- Balance
- Eye movements
- Hand and leg coordination
- Reflexes
- Speech
To make a final MS diagnosis, doctors need to:
- Rule out other conditions that could be causing your symptoms
- Find damage to at least two spots on your brain
- Prove that the damage happened at different times
Tests for MS Diagnosis
If your symptoms, medical history, and physical exam results point to MS, your doctor can order one or more tests to help them tell whether your brain and spinal cord are working as they should. These include:
MRI. This imaging test lets the doctor take a closer look at your brain. They can see changes caused by MS, like signs of inflammation or MS scars (lesions) in the deep parts of your brain or spinal cord.
Older people or those with high blood pressure and diabetes can have the same kinds of spots on a brain MRI. So the doctor will consider other information, including your symptoms, along with the MRI results before they make an MS diagnosis.
Also, an MRI result that says things are normal doesn't rule out MS. You could be one of a small number of people who have lesions in places the scan can't show.
Lumbar puncture. This test, which you may also hear called a spinal tap, checks the fluid that runs through your spinal column. Doctors use it to look for high levels of proteins called antibodies and other substances that are signs of the disease. It can help diagnose MS, but it, too, isn't absolute proof.
Blood tests. They can't diagnose MS, but the doctor will use them to look for substances in your blood that point to it. Most importantly, they can help your doctor rule out conditions that look like MS.
Eye exam. An eye exam could reveal problems that MS sometimes causes. Your doctor will test how well you can see detail far away, your field of vision, eye muscle strength, and pressure inside the eyeball, among other things. Possible MS-related conditions might include:
- Optic neuritis: This is damage to the optic nerve that often causes pain as well as blind spots surrounded by areas of normal vision.
- Nystagmus: Your eyes move rhythmically back and forth or up and down without conscious effort. This may be due to nerve damage, especially in the brainstem or cerebellum.
- Diplopia: This double vision happens due to damage to the nerve pathways that control the eyes. It can be an early symptom of MS.
Evoked potential test. If you have unusual symptoms, your doctor may do this test to check your nerve function. It uses electrodes to measure electrical activity in areas of your brain that are triggered by touch, sound, or light. This might happen while you look at a pattern on a screen, listen to clicking sounds, or get electrical pulses on your body.
McDonald Criteria for MS
The McDonald criteria, named for neurologist Ian McDonald, is a set of measures doctors follow to help them diagnose MS more accurately and quickly. First published in 2001, they've been revised several times.
To diagnose you with MS under these criteria, doctors need evidence that you have damage in more than one distinct part of your nervous system. You also need to have had symptoms typical of MS. These symptoms must have lasted at least 24 hours (not necessarily continuously), at a time when you had no fever or infection.
The evidence must show that this damage happened over time and corresponds to nerves involved in an MS attack. That could mean you've had two separate MS attacks at least 30 days apart. But you could be diagnosed after just one episode of symptoms if an MRI shows you have lesions from an earlier MS attack in a certain area of your brain.
The McDonald criteria take into account:
- Your symptoms
- How many attacks you've had
- Results of imaging tests like MRI
- Findings of optical coherence tomography, which examines your retinas
- Results of other tests, like those done on your spinal fluid after a lumbar puncture
Other possible causes of your condition also need to have been ruled out.
After MS Diagnosis
It may take a long time to get an MS diagnosis. If you've been waiting years or months, the news might be a relief. Or it could be a huge shock. Either way, you'll have concerns about what the disease means for your life and your family. That's completely understandable.
Talk with others — your friends, your doctor, a support group, or a counselor — about your feelings. Your health care team can help you decide the best ways to treat your disease and live with it day to day. MS affects everyone differently, so what works for one person with the condition may not be what's best for another.
Finding Specialists for MS Diagnosis
Your MS specialist will most likely be a neurologist. Neurologists are either Doctors of Medicine (MDs) or Doctors of Osteopathic Medicine (DOs) who have completed residencies in neurology. They'll have a broad understanding of diseases that involve your nervous system (such as MS).
Other members of your MS care team may be MDs or DOs who are trained in family medicine, internal medicine, or other specialties such as physical medicine and rehabilitation.
Nurse practitioners and physician assistants may also be involved in helping implement your treatment plan and helping you live your healthiest life.
Along with your general doctor, your MS specialist can give you extra care for your condition. They can:
- Personalize your MS care to your wants and needs
- Notify you when there are new medications or treatments for MS
- Alert you if there is a new clinical trial for MS
- Care for your emotional health and rehabilitation
- Consider your family's well-being during your treatment
- Help you return to a desirable level of function
- Help you meet your fitness goals
Takeaways
No one test can show whether you have MS, and many other conditions have similar symptoms. Your doctor may need to do several types of tests and exams before they can make an MS diagnosis. If you think you may have symptoms of MS, see your doctor. Prompt treatment can slow down the disease's progression and lead to fewer relapses.
MS Diagnosis FAQs
How can I test myself for MS?
There's no way to test yourself for MS, which is difficult even for doctors to diagnose. See a doctor if you have symptoms such as:
- An overwhelming feeling of tiredness
- Vision problems like blurriness or double vision
- Tingling and numbness, especially in your hands and feet
- Muscle weakness
- Dizziness or loss of balance
What is the first indicator of MS?
MS symptoms vary a lot from person to person.But many people first notice a problem with their vision.
What is most commonly mistaken for MS?
Research shows that people with MS are most commonly misdiagnosed as having:
- Migraine
- Radiologically isolated syndrome, which causes lesions like those of MS but usually has no symptoms
- Disorders of the vertebrae in your spine, called spondylopathy
- Nerve damage (neuropathy)
MS can resemble many other conditions, including:
- Lupus and other autoimmune diseases
- Lyme disease
- Stroke
- Amyotrophic lateral sclerosis
- Fibromyalgia
- Muscular dystrophy
- Underactive thyroid (hypothyroidism)
- Vitamin B12 deficiency
Does MS start suddenly?
Symptoms of MS differ from person to person. They can start over a few days, then get better quickly. Or they can progress slowly and gradually over a period of years. But they don't appear very suddenly like those of a stroke.
