How Is MS Diagnosed | National Multiple Sclerosis Society

• How Is Multiple Sclerosis Diagnosed?
• Possible MS
• Newly Diagnosed
• Clinically Isolated Syndrome (CIS)
• Other Conditions to Rule Out
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In this article

Overview of diagnosing MS


At this time, there are no symptoms, physical findings or laboratory tests that can, by themselves, determine if you have MS. Healthcare providers will use several strategies to determine if you meet the long-established criteria for an MS diagnosis and to rule out other possible causes of whatever symptoms you are experiencing. These strategies include a careful medical history, a neurologic exam and various tests including magnetic resonance imaging (MRI), cerebrospinal fluid analysis and blood tests to rule out other conditions.

Timely and accurate diagnosis

There are many possible causes of neurological symptoms. To diagnose MS, healthcare providers must first exclude these other causes through the tools and tests outlined below. While this process of exclusion may be quick for some, it can also take much longer and involve repeat testing, to look for changes.

Making the diagnosis of MS as quickly and accurately as possible is important for several reasons:

• You are living with frightening and uncomfortable symptoms and need to know the reason for your discomfort. Getting the diagnosis allows you to begin the adjustment process and relieves worries about other diseases.
• Since we now know that permanent neurologic damage can occur even in the earliest stages of MS, it is important to confirm the diagnosis so that you can start the appropriate treatment(s) as early in the disease process as possible.

Criteria for a diagnosis of multiple sclerosis

Currently MS is diagnosed by applying several types of tests and assessments because no single test or examination can confirm that you have MS. In order to make an MS diagnosis, the physician must:

• Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
• Find evidence that the damage occurred at different points in time AND
• Rule out all other possible diagnoses.


The McDonald Criteria, published in 2017 by the International Panel on the Diagnosis of Multiple Sclerosis, include specific guidelines for using MRI and cerebrospinal fluid analysis to speed the diagnostic process. The MRI can be used to look for a second area of damage in a person who has experienced only one attack (also called a “relapse” or an “exacerbation”) of MS-like symptoms — referred to as clinically-isolated syndrome (CIS). The MRI can also be used to confirm that damage has occurred at two different points in time. In some circumstances, the presence of oligoclonal bands in a person’s cerebrospinal fluid analysis can be used instead of dissemination in time to confirm the MS diagnosis.

Tests and tools for diagnosing MS

Healthcare providers have a series of tests and tools for diagnosing MS, which include learning your medical history and conducting neurologic exams, screening and imaging tests, and blood tests to rule out other potential causes of your symptoms.

Medical history and neurologic exam


Your healthcare provider:


• Takes a careful history to identify any past or present symptoms that might be caused by MS.
• Gathers information about birthplace, family history, environmental exposures, history of other illnesses and places visited that might provide further clues.
• Performs a comprehensive neurologic exam, which includes tests of cranial nerves (vision, hearing, facial sensation, strength, swallowing), nerve conduction (to test sensation in the extremities), reflexes, coordination, walking and balance.

In many instances, medical history and a neurologic exam provide enough evidence to meet the diagnostic criteria. Other tests are used to confirm the diagnosis or to identify other possible causes of the symptoms or neurological exam findings.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a diagnostic tool that offers the most sensitive, noninvasive way to examine the brain, spinal cord or other areas of the body. It is a valuable tool for diagnosing MS and tracking the progression of the disease.

Cerebrospinal fluid (CSF) analysis

Cerebrospinal fluid (CSF) is a clear, colorless liquid that surrounds the brain and spinal cord. In MS, damage to myelin causes certain types of proteins to be released into the spinal fluid. When these proteins are identified in the spinal fluid, but not in the blood, MS is thought to be one of the possible diagnoses. Spinal fluid is collected through a lumbar puncture (also known as a spinal tap). The CSF is then sent for testing and analysis.

Blood tests

While there is no definitive blood test for MS, blood tests can rule out other conditions that cause symptoms similar to those of MS, including lupus erythematosus, Sjogren’s syndrome, vitamin and mineral deficiencies, some infections and rare hereditary diseases.

Find an MS care provider

The National MS Society’s Partners in MS Care program connects you to local healthcare providers and medical facilities that have demonstrated exceptional care, knowledge and expertise in treating patients with MS. All partners, whether they are a neurologist or social worker, have a strong relationship with the Society and connect their patients to the information, resources and support they need to live their best lives with MS. Find a Partner in MS Care.

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Getting treatment for MS | MS Society

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You have the right to ask about getting treatment for your MS. This is true no matter what kind of MS you have – or how long you’ve had it.

Some treatments help with the symptoms of MS, while others control MS itself. With these treatments you can get fewer and less serious relapses, and disability progression may slow down.

First questions about MS treatments

Who do I ask about treating my MS?


It’s best you speak to an MS specialist, like a neurologist who has many patients with MS. An MS nurse can also talk about treatments in general. Only an MS specialist can give you advice on treating your MS and prescribe drugs for you.

To see your specialist you don’t have to wait for your next appointment to come round. You can ask to see them before then. Ask your GP or MS nurse to book one for you.

If you don’t already have an MS specialist, ask your GP to refer you to one.

> Find out who’s who in the health care system

When should I ask about treatment?


Official guidelines say everyone with MS should be offered an appointment with a specialist at least once a year to talk about their care. This is true no matter what kind of MS you have and whether you’re already on treatment or not. This is a chance to talk about how your MS might be treated.

If you haven’t seen a specialist for quite a long time you have the right to ask for an appointment. And if your yearly review doesn’t happen, you should ask your GP, MS nurse or neurologist about getting one scheduled. It’s never too late to think about treatment.

If you’ve just been told you have MS, guidelines say your neurologist should have spoken to you about treatment and given you information on it when you were diagnosed. Within six weeks of this you should get a follow-up appointment where you can talk about your treatment choices.

I have relapsing MS. What are my options?


If you have relapses with your MS, over a dozen drugs can now slow down this sort of MS and reduce relapses. They’re called disease modifying therapies (DMTs). Talk to your specialist about them if they haven’t already mentioned them.

DMTs won’t cure MS but they can slow it down and mean you get fewer relapses. They range from less hard hitting drugs with fewer side effects to stronger ones with more serious side effects.

There’s a wide range of drugs and other therapies that can help with specific MS symptoms. And steroids can help you get over a relapse sooner. Talk to your specialist, MS nurse or GP about these.

I’ve got relapsing MS and I don’t think drugs are working


There are a number of very effective DMTs for relapsing MS.

If you don’t feel the drug you’re taking is controlling your relapses well enough, talk over other possible MS relapse treatments with your neurologist or MS nurse.  This might include the stem cell therapy HSCT. In the UK HSCT is only an option if two DMTs haven’t worked for you.

My MS is progressive. Is there a treatment for me?


For most people with progressive MS DMTs don’t work. The exception is if your MS is progressive but is classed as ‘active’. This means you still get relapses, or doctors see inflammation on your MRI scans. If you have secondary progressive MS and it’s ‘active’ then two DMTs might help you – Extavia (which is one of the beta interferons) or siponimod (Mayzent).

A new DMT called ocrelizumab (Ocrevus) can work against primary progressive MS early on and if inflammation can be seen on your MRI scans. You also need to have a score on the Expanded Disability Status Scale (EDSS) between 3.0 and 6.5. A score of 6.5 means you need two walking aids – such as canes or crutches – to walk 20 metres without having a rest. This drug has been recommended for use on the NHS for this kind of MS since 2019 in England, Wales and Northern Ireland, and in Scotland since the start of 2020.

If your MS is progressive then HSCT isn’t likely to help you unless you have early primary progressive MS and inflammation is seen on your MRI scans.

But there are lots of treatments, therapies, lifestyle changes and devices that help with the symptoms or disability caused by progressive MS. Ask your GP, MS nurse or neurologist for help.

Our researchers are working to find treatments for progressive MS.

What to do when

I’m not happy with what my specialist says


Maybe you don’t agree with what your specialist says about treating your MS. Or perhaps you don’t understand the information they’ve given you.

It’s worth first talking to your neurologist about your concerns or if you’d like to consider a different course of treatment.

You can ask for a second opinion from another MS specialist. Discuss this with your neurologist, your GP or with the hospital or clinic where you were seen.

However, this could mean having to travel to a different hospital and your treatment could start later. Talk this through with your specialist to see what a delay might mean for you.

> Find out more about getting a second opinion on the NHS choices website

I’ve got a long wait to see my neurologist


It can be difficult to get an appointment with a neurologist and long waiting times are sometimes an issue.

Neurologists are meant to follow NICE recommendations and offer everyone with MS a comprehensive review of all aspects of their care at least once a year.

While you’re waiting to see your neurologist, we recommend speaking to your MS Nurse about your treatment options so you’re prepared when you see them.

If you’ve been waiting a long time for an appointment with a neurologist and are concerned about the impact on your MS, please get in touch with at [email protected]. Sharing your experiences helps us make the case locally for MS services and campaign for better access to treatments.

If you’ve been waiting a long time for an appointment with a neurologist and would like some information and support on what services are available to you, please contact our Helpline on 0808 800 8000 or at [email protected].

I’ve been denied an NHS treatment for my MS


When you have a diagnosis of relapsing MS, your neurologist should guide you through which treatments you’re eligible for and help you make a decision.

If you feel you’re not being prescribed a DMT you’re eligible for, this could be due to a number of different reasons. If you have a clinician who’s reluctant to prescribe you a treatment, that doesn’t mean you’re not eligible for any. It’s important to be aware of your treatment options before you see your specialist.

If you’re unclear about why you’re not being offered your preferred treatment option, we may be able to help. Contact your local Regional External Relations Officer who may be able to raise the issue with decision-makers locally.

I’ve been denied a NHS treatment that’s not currently approved for MS


Some treatments that could help you have either been rejected by your national level commissioner or haven’t been reviewed for treating MS on the NHS yet.

Whether you’ll have any success accessing these treatments will depend on how expensive they are for your local NHS to fund and whether national commissioners have explicitly recommended they shouldn’t be used.

For exceptional circumstances it is possible to receive NHS funding through applying for an individual funding request.

I want to explore Individual Funding Requests or Individual Patient Treatment Requests


To access treatments that haven’t been approved for MS on the NHS you may want to try to get an Individual Funding Request (IFR) or Individual Patient Treatment Request (IPTR) in Scotland. These are to request funding for people who are considered to have exceptional clinical circumstances. They have to be submitted by a healthcare professional.

These requests are submitted to your local commissioner. The treatments are not routinely available and it’s unlikely funding will be granted for a non-approved treatment where there are lots of people who’d like to access it for the same reason.

Your neurologist will be able to advise you on the likely success of submitting a request.

I want to get HSCT for my MS


HSCT is now being funded by the NHS for people with relapsing MS who have continued to have relapses despite taking two other DMTs. However, it’s not yet widely available.

NICE will review HSCT for the NHS in England and Wales once they have enough clinical trial evidence. This appraisal will decide whether it should be made more widely available.

> Find out more about HSCT

Find out about your rights in different parts of the UK

England and Wales


The National Institute of Health and Care Excellence (NICE) are responsible for approving DMTs for England and Wales. Once NICE approves a treatment, the NHS across England and Wales has three months to implement that guidance. Once that has happened patients are legally entitled to be prescribed the treatment (so long as they meet the eligibility criteria ).

Northern Ireland


The Department of Health, Social Service and Public safety has formal links with NICE. Once NICE approves a treatment it’s reviewed locally for applicability to Northern Ireland. Where appropriate it’s then endorsed for implementation in Health and Social Care (HSC). This process should be completed within 8 weeks.

Scotland


The Scottish Medicines Consortium (SMC) is responsible for approving DMTs in Scotland. When the SMC approves a DMT, the NHS boards in Scotland take it into account when they decide which medicines are available in their area. But they don’t have to follow the SMC decision.

Making an official complaint

Making a complaint in England and Wales


If a NICE approved treatment that you’re eligible to take is unavailable in your area, you can make an official complaint.

Officers from the Patient Advice and Liaisons Service (PALS) are available in all hospitals. They offer confidential advice, support and information on health-related matters to patients, their families and carer.

Making a complaint in Northern Ireland


If you have a complaint about your level of treatment you can contact the Patient and Client Council who support NHS patients with complaints in Northern Ireland.

> Find contact details for each health trust’s complaints department

Making a complaint in Scotland


If you have a complaint about your level of treatment you can contact the Patient Advice and Support Service (PASS) who provide free, confidential advice and support for NHS patients in Scotland.

Take political action


If you’re repeatedly denied a treatment you feel you’re eligible to take, you can contact your MP, SMP or Assembly Member to help you challenge the decision. Find out who your representatives are here.

Contact our MS Helpline on 0808 800 8000 for support and information about taking this step.

Talking about treatments – questions to ask my MS specialist

Medical tests for nurses online

1. Online tests

2. Medicine
3. For nurses

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Pediatric nursing tests with answers

Pediatric nursing tests for nurses


The correct answer is marked with +

1. Body weight in grams of a full-term baby should be:

+A) 3300-3600;

B) 3900 – 4200;

B) 2700 – 2900.

2. The body length of the newborn should be:

A) 46-48 cm;

+B) 50 – 52 cm;

B) 53 – 55 cm.

+B) 75 cm;

B) 60 cm.

4. Average head circumference of a newborn:

A) 30 – 32 cm;

B) 32 – 34 cm;

+B) 33 – 35 cm.

B) 33 – 36;

C) 35 – 37.

B) Ballard;

+B) Apgar.

7. It has a high energy value, nutrient content, rich in various immunity factors – these are:

A) Breast milk;

B) Adapted milk formula;

+B) Colostrum.

8. The first attachment to the mother’s breast should be carried out:

A) On the second day after birth;

B) 4 hours after delivery;

+B) In the first 30 minutes after birth.

9. Free feeding is:

+A) Attachment to the breast at the request of the child;

B) Breastfeeding every 3 hours with a break at night;

C) Application every three hours, including at night.

test 10. The neonatal period lasts:

A) one year after birth;

B) 6 months after birth;

+B) 1 month after birth.

11. Supplementary food is:

A) Dietary diversity;

+B) Supplementary food given to a child of the first year of life who does not have enough breast milk;

C) Introduction of new products into the diet in order to replenish the energy costs of the baby.

12. Complementary foods are:

A) Dietary diversity;

B) Supplementary food given to a child of the first year of life who does not have enough breast milk;

+B) Introduction of new products into the diet in order to replenish the energy costs of the baby.

13. Breast period continues after birth:

+A) 1 year;

B) 6 months;

C) How long a woman will breastfeed her baby.

14. The recommended daily amount of dairy products for children from one to two years of age is:

A) 300-400 ml;

B) 100 – 200 ml;

+B) 500 – 600 ml.

15. Children from 1 to 3 years of age are recommended milk:

+A) Children’s industrial modified;

B) Fresh whole cow;

C) Mass industrial production.

16. The following products should be included in the daily diet, except:

A) Vegetables;

+B) Fish;

C) Butter.

17. The frequency of respiratory movements in a newborn within the normal range is:

A) 60 – 70 per minute;

+B) 40 – 50 per minute;

C) 16 – 20 per minute.

18. The frequency of respiratory movements in a child of 5 years within the normal range is:

A) 30 – 35 per minute;

+B) 20 – 25 per minute;

B) 15 – 20 per minute.

19. The average value of the pulse rate in a newborn is:

A) 90 per minute;

B) 100 per minute;

+B) 130 – 140 per minute.

test-20. The average value of the pulse rate in a child of 10 years old is:

A) 100 per minute;

+B) 90 per minute;

B) 120 per minute.

21. With hypotrophy of the first degree in the postnatal period, body weight is reduced:

+A) 20%;

B) More than 35%;

B) 5%.

22. Paratrophy is:

A) Insufficient body weight within 10%;

+B) Overweight by more than 10%;

C) Excess growth of more than 10%.

23. Of all types of allergies in childhood, the most common:

+A) Food;

B) Medicinal;

C) Inhalation.

24. The following berries most often cause food allergies:

A) Currant;

+B) Strawberry;

C) Gooseberry.

25. The most common food allergies are the following vegetables;

+A) Tomatoes;

B) Courgette;

C) Carrot.

26. Flour almost never causes allergies:

A) Semolina;

B) Oatmeal;

+B) Soya.

27. The first complementary foods to prevent vitamin D deficiency should include the product:

A) Bread;

+B) Yolk;

C) Meat.

28. Early signs of rickets include:

+A) Increased sweating;

B) Change in the shape of the skull;

C) Curvature of the bones of the lower extremities.

29. One of the signs of “blue defect” in an infant is:

A) Sweating;

+B) Blue lips, fingers, neck;

C) Shortness of breath.

test_30. The appearance of “seizures” in the corners of the mouth may be the cause of the pathological condition:

A) Pneumonia;

+B) Iron deficiency anemia;

C) Atopic dermatitis.

31. BCG is administered to prevent the disease:

+A) Tuberculosis;

B) Pneumonia;

C) Hepatitis.

32. The appearance of a papule after the introduction of the BCG vaccine occurs:

A) a week later;

+B) After 3 months;

C) After 4 weeks.

33. Purulent skin lesions in newborns manifest themselves as:

A) Ritter’s disease;

B) Furunculosis;

+B) Vesiculopustulosis.

34. To confirm phenylketonuria, the following should be examined:

A) Blood;

+B) Urine;

C) Cal.

35. A reliable sign of asphyxia in a newborn is:

+A) Absence of breathing;

B) Decreased muscle tone;

C) Areflexia.

36. Birth injury occurs due to one of the following reasons:

A) Post-term pregnancy;

+B) Mismatch between the size of the pelvis of the woman and the head of the fetus;

C) Anomalies in the structure of genes.

37. Reactive conditions in newborns include all of the following except:

+A) Melena;

B) Breast engorgement;

C) Physiological jaundice.

38. The period of closure of the large fontanel is within the normal range:

+A) 1.5 – 2 years;

B) 6 months;

C) 2.5 years.

39. A potential problem with pyoderma is:

A) Diaper rash;

B) prickly heat;

+B) Sepsis.

test*40. Atopic dermatitis at an early age is manifested by the occurrence of:

A) Enlargement of the thyroid gland;

+B) Milk scab;

C) Neurasthenia.

41. It is possible to improve sputum discharge during productive cough if:

+A) Carry out vibration massage;

B) Place mustard plasters;

C) Administer antibiotics.

42. Using the Zimnitsky test, you can determine:

A) Color, volume, density of urine;

B) Glucose in urine;

+B) The concentration function of the kidneys.

43. Rashes on the skin in the form of vesicles are characteristic of an infectious disease:

A) Measles;

B) Scarlet fever;

+B) Chicken pox.

44. Treatment of the umbilical wound refers to:

+A) Independent nursing intervention;

B) Dependent nursing intervention;

C) Interdependent nursing intervention.

45. In case of allergic diathesis, the following should be excluded from the diet in the first place:

A) Apple juice;

+B) Oranges;

C) Kefir.

46. In what disease is scraping from perinatal folds performed for diagnostic purposes:

+A) Enterobiosis;

B) Ascariasis;

C) Trichuriasis.

47. The main symptom of bronchial asthma in a child:

A) Convulsions;

+B) Attack of suffocation;

C) Edema.

48. When there is a threat of stenosis of the larynx outside the medical institution, the tactics of a nurse:

+A) Urgent hospitalization;

B) Oxygen therapy;

C) ventilator.

49. The main sign of bleeding from the stomach or duodenum:

+A) Melena;

B) Pain in the gastrointestinal tract;

C) Vomiting.

tes No. 50. Leading sign of croup:

+A) Inspiratory dyspnea;

B) Temperature increase;

C) Redness of the face.

51. With glomerulonephritis in the urine of a child:

A) Bacteriuria;

+B) Hematuria;

C) Crystalluria.

52. Pyelonephritis in the urine of a child reveals:

+A) Bacteriuria;

B) Hematuria;

C) Crystalluria.

53. Epidemic parotitis can later lead to:

+A) Infertility;

B) Cystitis;

C) Pyelonephritis.

54. Head thrown back in the supine position may indicate a disease:

A) Myocarditis;

B) Pneumonia;

+B) Meningitis.

55. Late detection of diabetes mellitus can lead to the development of coma:

A) Hypoglycemic;

+B) Ketoacidotic;

B) Uremic.

56. Form 112 is:

A) Group diary;

+B) Child development history;

B) Isolator magazine.

57. The neonatal nurse is responsible for:

A) to bathe a child;

B) Measure blood pressure;

+B) Treat the umbilical wound, weigh the child.

58.