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

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Drug testing – at the KORSAKOV clinic

In Russia the problem of drug addiction is steadily growing. Worst of all, the age limit for addicts is going down. According to our observations, 10 to 20% of high school and first-year students have tried marijuana, opiates, or more potent drugs. With this problem it is necessary, and most importantly, it is possible to fight.

It is quite difficult to identify the fact of drug use, therefore, scientists have developed immunochemical diagnostic methods for this. The most well-known tests for the determination of drugs are immunochemical methods for the determination of narcotic substances, namely: homogeneous enzyme immunoassay, immunofluorescence, radioimmunoassay.

It is important to remember that drug test results cannot be used by law enforcement as they are considered preliminary .

For any legal consequences, a person must be tested as part of a forensic examination, and for this there must be sufficient grounds to believe that he uses drugs. Hence – complete anonymity and the inability to use the test results in court. In this regard, children and adolescents remain safe. The real threat to them is drug addiction.

The object of analysis is a biological fluid or surface swabs, as well as extracts obtained from the hair of people suspected of using drugs. All of the above tests for the determination of drugs are based on the detection in the human biological fluid of the metabolic products of the drug used. The production technology of various variants of test systems for determining the most common classes of drugs is based on enzyme-linked immunosorbent assay (ELISA).

Types of drug tests at the medical center “KORSAKOV”

In the KORSAKOV clinic, there are several classifications of drug tests . All drug tests are classified according to the type of biological material that is necessary for analysis, therefore, in such tests, blood and urine are most often used for diagnosis. Less common biological materials are sweat, saliva, hair and nails. There are also mono- and multi-test tests that allow you to detect in a biological fluid either for one drug or several drugs at once (up to 300 types of drugs), such tests are performed from 6 hours to 10 days. There are also special express tests that are carried out at the KORSAKOV medical center and allow you to get the result within 30 minutes.

Diagnosis of drug addiction (test for the content of narcotic substances in the body)

Rapid urine and saliva drug test

Conducted screening analysis of the biological environment for the content of alcohol, opioids, cannabinoids, cocaine, amphetamines, psychoactive substances (at the request of citizens).

Rapid test shows whether a person has taken drugs in the next 7 days. Any test can be taken anonymously. A drug test shows the presence in the body of all currently known drugs, the main ones are:

• Heroin;
• Cocaine;
• Methadone;
• Marijuana;
• Desomorphine;
• Methamphetamines;
• And others.

The drug test takes 20 minutes.
At the end of testing, documentary evidence (certificate of passing the test and the result) of the presence / absence of prohibited drugs in the body is issued. It is important to understand that the period of indications for the presence of drugs in the body (7 days) is the presence of drugs in the body.

Rapid drug test

Rapid test shows whether a person has taken drugs in the next month.

A drug test shows the presence in the body of the most common drugs at the moment, the main ones are:

• Heroin;
• Cocaine;
• Methadone;
• Marijuana;
• Desomorphine;
• Methamphetamines;
• And others.

The drug test takes 40 minutes.

Upon completion of testing, documentary evidence of the presence/absence of prohibited drugs in the body is issued. Average drug discovery time (1 month).

Comprehensive test (analysis) for the content of narcotic substances in the blood

Comprehensive test (analysis) for the content of narcotic substances in the blood of more than 200 types of substances.

A comprehensive test shows whether a person has taken drugs in the next 3 months.

A complete drug test shows the presence in the body of all currently known drugs, the main ones are:

• Heroin;
• Cocaine;
• Methadone;
• Speeds;
• Marijuana;
• Coaxil;
• Desomorphine;
• Methamphetamines;
• and many more.

Long response time (15 days).

Upon completion of testing, documentary evidence of the presence/absence of prohibited drugs in the body is issued. Long drug detection period (3 months).

Where can I take a drug test?

When faced with the problem of drug use , you need to act immediately. After all, every week spent means an increase in addiction and a deterioration in health. That is why the Rapid Drug Test can actually save the life of your child, relative or friend.

Currently, you can take tests or tests for drugs at the KORSAKOV medical center, very quickly and anonymously. It is the KORSAKOV Medical Center that can help in conducting such tests, if necessary. Everyone now has access to checking their own body for the presence of drugs (opiates, methamphetamines, marijuana, heroin, desomorphine and other illegal and deadly substances).

The KORSAKOV Center provides a wide range of clinical research services. around the clock.

KORSAKOV Medical Center guarantees complete anonymity of tests and non-disclosure of personal data. The center uses the most modern and high-quality test systems from the world’s best manufacturers, which guarantees the maximum accuracy of the results. No doubtful results – only accurate data. After the analysis, you can consult a doctor for free about the effect of certain substances on the body of a teenager.

Anonymous drug test without the knowledge of the patient at the KORSAKOV clinic

In order to diagnose a person without his knowledge, hair is most often used. With the help of hair, it is possible to reveal the fact of drug use in recent months. For analysis, hair from the head or other parts of the body is usually used. With the help of this method, it is possible to establish when and in what quantity the narcotic substance was taken. For this anonymous drug test without the knowledge of the patient, just a few hairs are enough. A prerequisite is taking the hair from the very roots.

Drug and alcohol test at the KORSAKOV clinic

Our clinic guarantees anonymity when taking a drug test. Having passed an anonymous drug test, it is possible to determine the addiction in a teenager in time and begin its treatment.

In addition to drug tests, the KORSAKOV clinic has alcohol tests that can be used to determine the level of alcohol in the body using saliva and exhaled air. You can take a drug and alcohol test at the KORSAKOV medical center at any time convenient for you, we work around the clock, call 8 (800) 555-40-23. In the medical center “KORSAKOV” the level of carbohydrate-deficient transferrin in the blood is determined, on the basis of which chronic alcoholism can be detected. This is a specific test that is not affected by liver disease or the presence of drugs in the body. Rapid tests for alcohol are of two types: test strips and indicator tubes.

What kind of drug tests are done and what do they reveal?

The drug test is a routine blood or urine test. Our experts prefer to take exactly urine, since this material can be painlessly obtained in the right amount, and analysis technologies have long been tested and have proven to be the most effective. The only thing that a urinalysis cannot show is the exact amount of the injected drug. That is, it demonstrates the very fact of smoking or injecting a particular drug, and additional data may show more detailed tests.

How are drugs identified for each category of substances?

Opiates. Heroin and desomorphine are two of the strongest drugs in the opium group. You can identify a heroin addict by drug testing. In the blood, it is rapidly converted to 6-acetylmorphine and, 2 hours after the dose, the half-life of morphine occurs. Therefore, a urinalysis can help the best. It will indicate the fact of the use of morphine during the last 2 days. The same applies to codeine-containing drugs. The most dangerous of them is desomorphine. It is also known as “crocodile” because of the irreversible changes that occur on the body: a crust appears, similar to crocodile skin. Urinalysis for drugs will also help identify the use of desomorphine.

Amphetamine and methamphetamine. Typically, this drug is administered intravenously or “sniffed”. A drug blood test can help identify a teenager who uses amphetamine or methamphetamine. Urinalysis can also be used for these substances.

Cocaine. Cocaine is a naturally occurring alkaloid (the drug is made from coca leaves). It affects the nervous system, stimulating euphoria and general emotional uplift. Cocaine is usually snorted, sometimes smoked or injected intravenously. A drug test will determine the amount of cocaine in the urine over the past six to eight hours.

Marijuana (cannabis). One of the most common soft drugs for many years has been weed. Marijuana, or hemp, affects the psyche. More precisely, the delta-9-tetra-hydrocannabinol (THC) component contained in hemp leaves has a narcotic effect. You can even check a teenager or student for the presence of drugs in the body, even a few weeks after the last dose. The THC component is stored in adipose tissue for a long period after smoking marijuana. A urine test will help identify it.

It is important to remember that the results of the analysis cannot be used by law enforcement agencies, as they are considered preliminary. For any legal consequences, a person must be tested as part of a forensic examination, and for this there must be sufficient grounds to believe that he uses drugs.

Hence – complete anonymity and the inability to use the test results in court. In this regard, children and adolescents remain safe. The real threat to them is drug addiction.

Any test to be taken anonymously

Testing by appointment or on a first-come, first-served basis, as you wish.

Pre-registration can be done by calling 8 (800) 555-40-23 at any time.

Drug addiction treatment provided

Andrei Mikhailovich ORLOV

Leading specialist, psychiatrist-narcologist

Polina Sergeevna NOSOVA

Senior Researcher. Leading psychiatrist

Sergey Vladimirovich KURENKOV

Clinical psychologist.