How do doctors diagnose multiple sclerosis. What tests are used to confirm MS. Can a single test definitively diagnose multiple sclerosis. What are the McDonald criteria for MS diagnosis. How long does it take to get an MS diagnosis.

Understanding Multiple Sclerosis: Challenges in Diagnosis

Diagnosing multiple sclerosis (MS) presents a significant challenge for medical professionals. Why is MS so difficult to diagnose? The complexity lies in the absence of a single, definitive test that can conclusively prove the presence of the disease. Moreover, many other conditions share symptoms similar to those of MS, further complicating the diagnostic process.

The journey to an MS diagnosis often begins when a patient or their primary care physician notices certain signs or symptoms that could potentially indicate MS. These symptoms may include:

• Numbness or tingling in the hands or feet
• Unusual weakness in arms, legs, or fingers
• Slurred speech
• Difficulty walking or stumbling
• Double vision or loss of color perception
• Visual disturbances such as flashing lights
• Eye pain that worsens with movement

When these symptoms persist for more than a couple of days, even if they subside on their own, it may be time to consult a neurologist specializing in MS. Early diagnosis and treatment can significantly impact the course of the disease.

The Role of Neurologists in MS Diagnosis

Neurologists play a crucial role in diagnosing and treating multiple sclerosis. These specialists are trained to recognize the subtle signs and symptoms of MS and differentiate them from other neurological conditions. How do neurologists approach MS diagnosis? They employ a comprehensive strategy that involves:

1. Conducting a thorough medical history and physical examination
2. Assessing the patient’s symptoms and their progression over time
3. Ordering and interpreting various diagnostic tests
4. Applying established diagnostic criteria, such as the McDonald criteria
5. Ruling out other conditions that may mimic MS symptoms

By combining their expertise with advanced diagnostic tools, neurologists aim to provide an accurate diagnosis and develop an appropriate treatment plan for individuals suspected of having MS.

Diagnostic Tests for Multiple Sclerosis

While no single test can definitively diagnose MS, several diagnostic tools are used in combination to build a comprehensive picture of the patient’s condition. What are the primary tests used in MS diagnosis?

Magnetic Resonance Imaging (MRI)

MRI is a cornerstone in MS diagnosis. How does MRI help in diagnosing MS? This imaging technique allows doctors to visualize the brain and spinal cord in detail, revealing areas of inflammation and damage characteristic of MS. MRI can detect:

• Lesions or plaques in the central nervous system
• Signs of active inflammation
• Changes in brain volume over time

It’s important to note that while MRI is highly useful, a normal MRI result doesn’t entirely rule out MS. Some patients may have lesions in areas not easily visible on scans.

Lumbar Puncture (Spinal Tap)

A lumbar puncture involves collecting and analyzing cerebrospinal fluid (CSF). What does a spinal tap reveal about MS? This procedure can help identify:

• Elevated levels of certain proteins in the CSF
• The presence of oligoclonal bands, which are indicative of an immune response within the central nervous system
• Other markers of inflammation or neural damage

While not definitive on its own, a lumbar puncture can provide valuable supporting evidence for an MS diagnosis.

Blood Tests

Blood tests are primarily used to rule out other conditions that may mimic MS symptoms. What can blood tests reveal in the context of MS diagnosis? They can help:

• Exclude infections or other autoimmune diseases
• Check for vitamin deficiencies that might cause neurological symptoms
• Assess overall health and identify any comorbidities

While blood tests cannot diagnose MS directly, they play a crucial role in the differential diagnosis process.

The McDonald Criteria: A Standardized Approach to MS Diagnosis

The McDonald criteria, named after neurologist Ian McDonald, provide a standardized framework for diagnosing MS. How do the McDonald criteria work? These guidelines aim to:

• Streamline the diagnostic process
• Ensure consistency across different healthcare settings
• Allow for earlier diagnosis and treatment initiation

The criteria have been revised several times since their introduction in 2001, with the latest update reflecting the most current research in MS.

To receive an MS diagnosis under the McDonald criteria, patients must meet specific requirements. What are the key components of the McDonald criteria?

1. Evidence of damage in more than one distinct area of the central nervous system
2. Symptoms typical of MS that have lasted at least 24 hours
3. Proof that the damage occurred at different points in time
4. Exclusion of other potential causes for the symptoms

By applying these criteria, neurologists can make more accurate and timely MS diagnoses, leading to earlier intervention and potentially better outcomes for patients.

Specialized Tests in MS Diagnosis

In addition to the core diagnostic tools, several specialized tests can provide further insights into a patient’s condition. What additional tests might be used in MS diagnosis?

Evoked Potential Tests

Evoked potential tests measure the electrical activity in the brain in response to specific stimuli. How do evoked potential tests contribute to MS diagnosis? These tests can:

• Detect slowed nerve conduction, even in areas without obvious symptoms
• Provide evidence of damage to the optic nerves, sensory nerves, or auditory pathways
• Help identify subclinical lesions that may not be visible on MRI

There are three main types of evoked potential tests used in MS diagnosis: visual, auditory, and somatosensory.

Optical Coherence Tomography (OCT)

OCT is a non-invasive imaging technique that can measure the thickness of the retinal nerve fiber layer. How does OCT assist in MS diagnosis? This test can:

• Detect thinning of the retinal nerve fiber layer, which is common in MS
• Monitor changes in retinal structure over time
• Provide insights into overall neurodegeneration in MS

While not a standalone diagnostic tool, OCT can offer valuable supporting evidence in the diagnostic process.

Differential Diagnosis: Ruling Out MS Mimics

A critical aspect of MS diagnosis is the exclusion of other conditions that may present with similar symptoms. What are some conditions that can mimic MS? The differential diagnosis process considers:

• Other demyelinating disorders (e.g., neuromyelitis optica, acute disseminated encephalomyelitis)
• Vascular diseases (e.g., small vessel ischemic disease)
• Infectious diseases (e.g., Lyme disease, syphilis)
• Autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome)
• Structural abnormalities (e.g., cervical spondylosis)
• Metabolic disorders (e.g., vitamin B12 deficiency)

Thorough evaluation and testing are essential to differentiate MS from these conditions and ensure an accurate diagnosis.

The Journey After MS Diagnosis

Receiving an MS diagnosis marks the beginning of a new chapter in a patient’s life. What happens after an MS diagnosis is confirmed? The post-diagnosis journey typically involves:

1. Developing a comprehensive treatment plan
2. Exploring disease-modifying therapies to manage symptoms and slow disease progression
3. Establishing a support network, including healthcare providers, family, and support groups
4. Making lifestyle adjustments to accommodate the challenges of living with MS
5. Regular follow-up appointments and monitoring to track disease progression and treatment efficacy

Early intervention and ongoing management are crucial in optimizing outcomes for individuals living with MS.

Advancements in MS Diagnosis: Looking to the Future

The field of MS diagnosis is continuously evolving, with researchers exploring new techniques and biomarkers to improve diagnostic accuracy and speed. What future developments might we see in MS diagnosis?

• Advanced imaging techniques, such as 7-Tesla MRI, offering higher resolution and sensitivity
• Blood-based biomarkers for easier and less invasive diagnosis
• Artificial intelligence and machine learning algorithms to assist in interpreting diagnostic data
• Improved understanding of genetic factors contributing to MS risk and progression

These advancements hold promise for earlier, more precise diagnoses and personalized treatment approaches for individuals with MS.

In conclusion, while diagnosing multiple sclerosis remains a complex process, the combination of clinical expertise, advanced diagnostic tools, and standardized criteria has significantly improved our ability to identify and manage this challenging condition. As research progresses, we can anticipate further refinements in diagnostic techniques, leading to more timely interventions and better outcomes for those affected by MS.

How Doctors Test for MS

Written by WebMD Editorial Contributors, Alexandra Benisek

Medically Reviewed by Jennifer Robinson, MD on January 24, 2023

• What Do Doctors Look For?
• Multiple Sclerosis Tests
• McDonald Criteria for MS
• After a Multiple Sclerosis Diagnosis
• MS Specialists

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no single test that can prove you have it. And many conditions have symptoms that seem like those of MS.

A neurologist – a doctor who specializes in treating the disease – should be able to help. They’ll ask how you’re feeling and help you figure out if your symptoms mean you have MS or another problem.

MS can take some time and a number of tests to diagnose. It starts when you or your doctor notices certain signs or symptoms that could be MS. These might include:

• Numbness or tingling in the skin (typically, hands or feet)
• Unusual weakness in 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 with movement

When you first notice these symptoms, especially if they are 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, even if they go away on their own, it may be time to see a neurologist who specializes in MS to speed up diagnosis and start treatment.

If your doctors suspect MS, they will look for further symptoms and signs that suggest MS. To make a final MS diagnosis, they will use several tools to try and do three things:

• Rule out any other conditions that could cause your symptoms
• Find damage to at least two spots on your brain
• Prove the damage happened at different points in time 

These tests will help your doctor know if 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 multiple sclerosis, like signs of inflammation in the deep parts of your brain or spinal cord.

Older people or those with high blood pressure and diabetes also can have the same kinds of spots on a brain MRI. So the doctor will consider other info, including your symptoms, along with the scan results or the enhancement of lesions before they make a 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.

Learn more about using MRI to diagnose MS.

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 and other substances that are signs of the disease. It can help diagnose MS, but it, too, isn’t absolute proof.

Know what to expect with a spinal tap to diagnose MS.

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.

Get more information about other types of demyelinating disorders 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: Damage to the optic nerve that often causes pain as well as blind spots surrounded by areas of normal vision
• Nystagmus: Eyes move rhythmically back and forth or up and down without conscious effort. May be due to nerve damage, especially in the brainstem or cerebellum.
• Diplopia: Double vision that 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 to check your nerve function. This test uses electrodes to measure electrical activity in areas of your brain 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.

The McDonald criteria, named for neurologist Ian McDonald, are measures aimed at helping doctors diagnose MS more accurately and quickly. First published in 2001, they’ve been revised several times, according to the latest research.

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 MS lesions that occurred earlier 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.

It may take a long time to figure out that you have MS. 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 you.

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 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 to live your healthiest life.

In addition to your general doctor, your MS specialist can give you extra care for your condition. They can:

• Personalize your MS care to your specific 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.

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How Doctors Test for MS

Written by WebMD Editorial Contributors, Alexandra Benisek

Medically Reviewed by Jennifer Robinson, MD on January 24, 2023

• What Do Doctors Look For?
• Multiple Sclerosis Tests
• McDonald Criteria for MS
• After a Multiple Sclerosis Diagnosis
• MS Specialists

It can be a challenge for doctors to diagnose multiple sclerosis (MS). There’s no single test that can prove you have it. And many conditions have symptoms that seem like those of MS.

A neurologist – a doctor who specializes in treating the disease – should be able to help. They’ll ask how you’re feeling and help you figure out if your symptoms mean you have MS or another problem.

MS can take some time and a number of tests to diagnose. It starts when you or your doctor notices certain signs or symptoms that could be MS. These might include:

• Numbness or tingling in the skin (typically, hands or feet)
• Unusual weakness in 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 with movement

When you first notice these symptoms, especially if they are 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, even if they go away on their own, it may be time to see a neurologist who specializes in MS to speed up diagnosis and start treatment.

If your doctors suspect MS, they will look for further symptoms and signs that suggest MS. To make a final MS diagnosis, they will use several tools to try and do three things:

• Rule out any other conditions that could cause your symptoms
• Find damage to at least two spots on your brain
• Prove the damage happened at different points in time 

These tests will help your doctor know if 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 multiple sclerosis, like signs of inflammation in the deep parts of your brain or spinal cord.

Older people or those with high blood pressure and diabetes also can have the same kinds of spots on a brain MRI. So the doctor will consider other info, including your symptoms, along with the scan results or the enhancement of lesions before they make a 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.

Learn more about using MRI to diagnose MS.

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 and other substances that are signs of the disease. It can help diagnose MS, but it, too, isn’t absolute proof.

Know what to expect with a spinal tap to diagnose MS.

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.

Get more information about other types of demyelinating disorders 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: Damage to the optic nerve that often causes pain as well as blind spots surrounded by areas of normal vision
• Nystagmus: Eyes move rhythmically back and forth or up and down without conscious effort. May be due to nerve damage, especially in the brainstem or cerebellum.
• Diplopia: Double vision that 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 to check your nerve function. This test uses electrodes to measure electrical activity in areas of your brain 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.

The McDonald criteria, named for neurologist Ian McDonald, are measures aimed at helping doctors diagnose MS more accurately and quickly. First published in 2001, they’ve been revised several times, according to the latest research.

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 MS lesions that occurred earlier 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.

It may take a long time to figure out that you have MS. 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 you.

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 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 to live your healthiest life.

In addition to your general doctor, your MS specialist can give you extra care for your condition. They can:

• Personalize your MS care to your specific 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.

Top Picks

Multiple sclerosis

Multiple Sclerosis (MS) is a chronic, incurable autoimmune disease. Pathological processes (demyelination) affect the myelin sheaths of neurons in the brain and spinal cord. Healthy tissue is replaced by dense connective tissue, of a scar type. It does not conduct nerve impulses, which leads to various neurological symptoms.

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Diagnosis of multiple sclerosis at the initial stage of the disease is difficult. It is important to have complete, regular medical check-ups. In this case, you can fix the onset of the disease and begin timely treatment. This will help to significantly slow down pathological changes and prolong the patient’s ability to work for a long time.

Causes of multiple sclerosis

At the moment, the exact cause of the disease has not been established. Some of the most likely factors influencing the development of MS are:

• transferred viral or bacterial infections;
• prolonged exposure to increased radiation field;
• chronic poisoning with toxic substances;
• poor quality, malnutrition;
• unfavorable ecological situation;
• past trauma;
• frequent stressful situations.

According to statistics, the disease often occurs at a young age, up to 40 years. However, it is rare, but still occurs both in children under 15 years of age and in people of the older generation. It is more often diagnosed in females, and one man is diagnosed with sick women. Not only gender matters, but also race. Representatives of the Caucasian race are more prone to multiple sclerosis.

The incidence is higher in large, industrial cities, which may indicate the impact of unfavorable environmental conditions and stress. Russia belongs to the high-risk zone, since more than 30 patients are diagnosed here for every 100,000 people.

Manifestation of multiple sclerosis

Symptoms depend on the location of the most severe demyelination.

1. If the pyramidal system is affected:

• Increased tendon-periosteal reflexes that occur in response to stimuli.
• Decreased muscle strength and increased muscle fatigue while maintaining functionality.
• Tetraparesis – increased tone of a separate muscle group.

2. If the cerebellum is affected:

• Ataxia (impaired coordination of movements) of the trunk and limbs.
• Intentional tremor (oscillations of the whole body or parts of it due to uncontrolled muscle contractions).
• Muscular hypotension (decreased muscle tone and strength up to paresis).

3. When neurons are affected, paralysis of the following nerves can be observed:

• facial;
• oculomotor;
• sublingual;
• trigeminal nerve.

4. Other symptoms of MS:

• bulbar and pseudobulbar syndromes;
• nystagmus – involuntary eye movements;
• joint and muscle pain;
• loss of tactile sensitivity;
• the occurrence of a feeling of pressure in the limbs;
• superficial tingling in the fingers;
• incontinence and retention of urine and defecation;
• violation of sexual function;
• decrease in visual acuity and quality (loss of brightness, distorted color perception).

In multiple sclerosis, neuropsychological changes are also observed. They consist in changing habits, reducing mental abilities, resulting in specific organic dementia. Patients suffer from depression, followed by periods of euphoria, often losing control of their emotions. Emotional instability, i.e., rapid mood swings, is considered one of the early symptoms. To assess the severity of symptoms, a scale from 0 to 6 is used, and the degree of disability of a MS patient in points from 0 to 10 on the EDSS scale.

Multiple sclerosis diagnostics

The disease does not have characteristic, inherent only to it symptoms. Therefore, differential diagnosis is always carried out. The doctor needs to exclude a large number of congenital pathologies and diseases of the nervous system. Systemic lupus, stroke, Sjögren’s syndrome, Parkinson’s and Behcet’s diseases have similar changes.

1. Laboratory diagnostics

When conducting a general blood test, a change in indicators makes it possible to suspect the development of multiple sclerosis. These include:

• The concentration of lymphocytes is an increased content of up to 40% or more.
• The number of leukocytes is less than normal.
• The erythrocyte sedimentation rate is increased.

Checking for an autoimmune failure will help puncture the cerebrospinal fluid. In MS, it will show a high percentage of immunoglobulins and oligoclonal antibodies (IgG antibodies). You can analyze the state of the immune system by making an immunogram. To do this, it is necessary to donate venous blood for a comprehensive study. It is aimed at identifying the concentration of lymphocytes and immunoglobulins of various types. As a rule, in RSV, the concentration of immune cells is increased, indicating an autoimmune process, and other parameters are reduced, as a result of a weakened body’s defenses.

2. Instrumental diagnostics

Electromagnetic superposition scanning of brain structures (SPEMS) or an electroencephalogram is currently considered the most effective. Scanning allows you to diagnose multiple sclerosis at an early stage of development, when neurological signs are absent or mild. However, SPEMS has a high error, changes are detected in one case out of three.

The essence of the method lies in the detection of focal loss of myelin. In the presence of pathological changes, the conduction of nerve impulses is disturbed. It is carried out through the placement of several sensors that monitor bioelectric impulses on the patient’s head. The result is an electroencephalogram – a graphic representation of an oscillatory electrical process.

3. Magnetic resonance and computed tomography

To assess the state of the nervous system and diagnose MS allows computer and magnetic resonance diagnostics. The use of a contrast solution helps to increase the efficiency of the study. The drug is administered intravenously, does not cause any sensations and discomfort.

The degree of sensitivity of tomography is extremely high, reaching an accuracy of 95%. Allows you to accurately diagnose multiple sclerosis in the following cases:

• detection of 4 or more foci of demyelination;
• the diameter of the lesion of nerve fibers from 3 mm;
• lesions are located in the nerve fibers, in the cranial fossa, adjacent to the lateral stomachs.

The contrast solution helps not only to increase visibility, but in itself is a marker of the presence of pathology. Its accumulation in the lesions indicates an active inflammatory process. Similarly, a tomogram of the spinal cord is performed.

Treatment

Multiple Sclerosis is a chronic disease with no cure. All measures are aimed at slowing down the development of the disease, relieving symptoms and reducing the frequency of exacerbations. There is no single treatment plan, each patient requires an individual approach.

The relapsing nature of the disease, characterized by periods of weakening and intensification of symptoms, needs symptomatic treatment, prevention of exacerbations, and inhibition of the transition to the active stage. In the secondary, progressive form, the main goal of therapy is to slow down the development of sclerosis. The doctor must understand at what stage the patient is. to correct his condition. To do this, the patient regularly takes prescribed tests, undergoes research, more often it is an MRI and an immunological blood test.

Do not forget that in addition to physiological symptoms, the patient undergoes a psychological change in personality. May become depressed, experience chronic fatigue, anxiety and depressive disorders. In multiple sclerosis, there is a wide range of mental disorders: from personality disorders to altered psychotic states. It also requires attention from the doctor.

Main tasks of treatment:

• Prevent exacerbations.
• Slow down the course of the disease.
• Prevent the development of new symptoms, reduce their severity.
• To alleviate the course of the current symptoms, help the patient to lead his usual way of life.

An important role is played by the social adaptation of the patient and timely psychological assistance. Despite the fact that the diagnosis of multiple sclerosis is made by a neurologist, a number of specialists are involved in the treatment: an immunologist, an electrophysiologist, a neuro-ophthalmologist, a neuropsychologist, and a urologist.

Treatment of exacerbations and symptoms

The first task that the doctor faces is to stop the active inflammatory process of the myelin sheaths. To do this, the attending physician prescribes the necessary drugs that have an immunostimulating effect, which alleviate the severity of symptoms.

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• All types of laboratory tests, including for diagnosing MS.
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What can be mistaken for multiple sclerosis?

03/21/2023

The title of the article was suggested to us by a community member in our VKontakte group. We decided to answer this question in detail, a little scientifically, but trying to use understandable language.

Multiple sclerosis is a difficult disease to diagnose. In this article, we will analyze the basic principles of the so-called differential diagnosis – a step-by-step examination to rule out diseases similar to MS.

Other demyelinating diseases

Previously, all demyelinating diseases were multiple sclerosis. However, over time, with the development of diagnostics, other demyelinating diseases of the central nervous system began to be isolated. Currently, in addition to multiple sclerosis, they include: Devic’s neuromyelitis optica, neuromyelitis optica spectrum disease, acute disseminated encephalomyelitis, and recurrent optic neuritis. These diseases are very similar to multiple sclerosis both in their manifestations (impaired functions in humans) and changes in MRI. To make a final diagnosis, additional examinations are required, and sometimes we take a break for diagnostics and observe the patient for some time.

Systemic diseases

This is a group of autoimmune diseases, which, like in multiple sclerosis, are based on a malfunction in the immune system. But unlike multiple sclerosis, when changes are localized exclusively in the brain and spinal cord, immunity in systemic diseases begins to damage various organs: joints, heart, kidneys, including the brain. One of the important links in the development of a systemic disease is vasculitis – an autoimmune inflammation of small vessels. There are small vessels in all organs, including the brain, so small scattered areas of damage can occur in the areas of blood supply to small vessels.

There are many systemic diseases: antiphospholipid syndrome, systemic lupus erythematosus, systemic vasculitis, Sjögren’s syndrome, Behcet’s disease, sarcoidosis, etc. On MRI, lesions in such diseases usually differ from those in multiple sclerosis, but at the beginning of the disease, when the changes are mild, implicit, a fairly wide additional examination in the form of blood tests is required, since MRI does not give an unambiguous answer to the nature of the foci. And one more thing: a person can have two diseases at the same time – both systemic and multiple sclerosis. In this case, deep knowledge and experience of the doctor is required to make the correct diagnosis and select therapy.

Hereditary diseases

Among the genetic diseases there are those similar to multiple sclerosis with onset at a young age, with various dysfunctions and foci on MRI. These include mitochondrial encephalopathy, adrenoleukodystrophy, Leber’s disease, CADASIL syndrome, etc. But still, each of these diseases has unique features that clearly indicate a genetic disease. Sometimes we have to do a genetic test to rule out such diseases.

Infections

Bacteria and viruses can selectively damage the brain and spinal cord, causing infectious encephalitis and myelitis. But an infection is an infection, and such lesions occur with fever and symptoms that clearly indicate an infectious lesion of the central nervous system.

It is much more difficult to distinguish multiple sclerosis from Lyme disease – neuroborreliosis. Borrelia are also bacteria that enter the human body with a tick bite. The peculiarity of borrelia is that they not only directly affect the brain, which forms foci similar to foci in MS, but also that the immune system, fighting with borrelia, begins to produce antibodies to them. But these antibodies can be so special in structure that they can recognize not only Borrelia, but also components of the nervous system and cause an immune response already on these tissues, in particular on the white matter of the brain or spinal cord. Those. in this case, the action of Borrelia will be mediated through a malfunction in the immune system. And in this case, we need to conduct additional examinations, including blood and cerebrospinal fluid tests to distinguish between neuroborreliosis and multiple sclerosis.

The AIDS syndrome may present with what is known as progressive multifocal leukodystrophy (PML). PML develops in people with a long history of HIV infection, when, due to lack of treatment or the nature of the course of the infection, such a decrease in immunity occurs that an infection with another virus, called Jc, develops. This virus begins to rapidly damage the white matter of the brain, often leading to death.

Migraine

The main manifestation of migraine is paroxysmal, often unilateral, throbbing headache. However, pain is often preceded by a complex of manifestations, symptoms, indicated by an aura. Sometimes the aura may be accompanied by decreased vision in one eye, weakness of the limbs, numbness of the arm or leg, dizziness, impaired sense of smell.

As can be seen, both reduced vision in one eye and weakness/numbness of the extremities can be manifestations of multiple sclerosis. The main distinguishing feature is the duration of the symptoms: with a migraine, they last from several minutes to half an hour and must completely disappear, giving way to a headache.

Migraine MRI may show lesions in the brain, but they are completely different from the demyelination lesions found on imaging in people with MS.

Stroke

Sudden occlusion of a vessel that supplies blood to a part of the brain leads to acutely developing symptoms: unilateral weakness of the limbs, impaired speech, unilateral visual field loss, and facial distortion.

However, a stroke is quite easy to distinguish from an exacerbation of multiple sclerosis: in MS, symptoms rarely occur acutely, not within seconds or minutes, as in a stroke, but over hours or days. On MRI of the brain in stroke, a site of cerebral infarction is visible: zones of irreversible damage to nerve cells, while in MS we see scattered foci of inflammatory changes. These changes are quite easy to distinguish from each other.

Tumors

Primary tumors can occur in the brain: astrocytomas, glioblastomas, meningiomas, etc. If manifestations, disturbances in the functioning of the nervous system sometimes resemble exacerbations in multiple sclerosis, then MRI can quite definitely indicate a tumor, It’s hard to confuse it with RS.

Brain metastases are another matter: there are usually many small foci that accumulate contrast, which may resemble an exacerbation of multiple sclerosis. However, the presence of a primary tumor in the body and certain characteristics on MRI make it possible to reliably distinguish metastases from MS foci.

Finally, lymphoma: this tumor often resembles multiple sclerosis and affects the lymphatic system of the brain and spinal cord. It often takes a lot of effort to rule out lymphoma.

Thus, a specialist in multiple sclerosis needs knowledge, a correct interpretation of the picture of the disease in order not to prescribe excessive tests, but to perform the necessary range of examinations to exclude similar diseases and make the correct diagnosis: do not get confused in the symptoms and not “confuse multiple sclerosis with something or else.