Multiple Sclerosis (MS) Diagnosis: Symptoms, Testing, and Next Steps

Multiple Sclerosis (MS) is diagnosed through a combination of clinical evaluations, MRI scans, spinal fluid analysis, and ruling out other conditions. Early signs like vision changes, numbness, and fatigue often prompt testing. 

A neurologist will confirm MS if there’s evidence of nerve damage in at least two areas of the central nervous system (CNS) occurring at different times. Early diagnosis is critical to slow disease progression and manage symptoms effectively.

Key Takeaways:

1. Symptoms Trigger Testing: Vision issues, numbness, fatigue, balance problems, and weakness prompt evaluation.
2. Diagnostic Steps: Includes history review, exam, MRI (lesions), spinal tap (bands), and blood tests (rule out mimics).
3. McDonald Criteria Key: Focuses on lesions in space (DIS) and over time (DIT) via MRI.
4. Misdiagnosis Risk: Symptoms overlap with other conditions, leading to initial errors.
5. Advanced Testing Available: OCT and sNfL blood tests offer additional diagnostic clues.
6. Post-Diagnosis Actions: Start DMT, build care team, adjust lifestyle, consider clinical trials.

Early Signs of MS: What to Watch For

MS is an autoimmune disease where the immune system attacks the protective myelin sheath around nerves in the brain and spinal cord. Recognizing early symptoms can lead to faster diagnosis and treatment.

Common Early Symptoms

• Vision problems (optic neuritis): Blurred vision, eye pain, or temporary vision loss.
• Numbness or tingling: Often in the face, arms, legs, or torso.
• Fatigue: Overwhelming tiredness unrelated to activity levels.
• Balance issues: Dizziness, clumsiness, or difficulty walking.
• Muscle weakness: Especially in the legs.
• Bladder/bowel dysfunction: Frequent urination or constipation.

Example: A 28-year-old runner notices sudden foot numbness during a workout. After weeks of fatigue, they see a neurologist. It is important to listen to your body when you feel that something is wrong. Even a simple way to enhance your natural fitness abilities is to listen to your body.

How MS is Diagnosed: A Step-by-Step Guide

McDonald 2017 Diagnostic Requirements

Clinical Presentation	Additional Requirements for MS Diagnosis
≥2 attacks with objective clinical evidence of ≥2 lesions	None – Clinical evidence is sufficient
≥2 attacks with objective evidence of 1 lesion	Evidence of dissemination in space via MRI
1 attack with objective evidence of ≥2 lesions	Evidence of dissemination in time via MRI
1 attack with objective evidence of 1 lesion	Evidence of both dissemination in space and time via MRI

Diagnosing MS requires eliminating other neurological conditions. Here’s the process:

Step 1: Clinical History and Symptom Review
A neurologist will ask about symptom frequency, duration, and patterns (e.g., flare-ups followed by remission).

Step 2: Neurological Exam
Tests for: Reflexes, coordination, vision, speech, and sensory responses.

Key red flags: Abnormal eye movements, poor balance, or uneven reflexes.

Step 3: MRI Scans (Magnetic Resonance Imaging)
Purpose: Detects lesions (areas of damage) in the brain and spinal cord.

What shows up: Bright spots (plaques) indicating demyelination.

85-95% accuracy in identifying MS when combined with clinical findings.

Step 4: Lumbar Puncture (Spinal Tap)
Tests for: Oligoclonal bands (proteins) in cerebrospinal fluid (CSF), which occur in 75-85% of MS patients.

Step 5: Evoked Potential Tests
Measures electrical activity in the brain in response to stimuli (e.g., flashing lights for visual evoked potentials).

Step 6: Blood Tests
Rules out mimics like Lyme disease, lupus, or vitamin B12 deficiency.

Why MS Diagnosis is Challenging

MS symptoms often overlap with other conditions. 20% of MS cases are misdiagnosed initially, according to a 2022 study in Neurology.

Conditions That Mimic MS

• Migraine with aura (vision disturbances).
• Fibromyalgia (chronic pain and fatigue).
• Lyme disease (joint pain, neurological issues).
• Vitamin deficiencies (B12, D).

Expert Insight:
“MS is a diagnosis of exclusion. We need to see evidence of CNS damage over time and space.”
— Dr. Sarah Thompson, Neurologist at Johns Hopkins Medicine

The McDonald Criteria: Gold Standard for Diagnosis

The McDonald Criteria (revised in 2017) streamline MS diagnosis by focusing on:

• Dissemination in space (DIS): Lesions in ≥2 CNS areas.
• Dissemination in time (DIT): New lesions forming over months.

Example: A patient with optic neuritis and a new spinal cord lesion 6 months later meets the criteria.

Advanced Testing and Emerging Tools

Optical Coherence Tomography (OCT)
Scans the retina to detect thinning caused by optic neuritis.

Serum Neurofilament Light Chain (sNfL)
Blood test measuring nerve damage biomarkers. 90% specific for MS in clinical trials.

What to Do After an MS Diagnosis

Start Disease-Modifying Therapy (DMT):

• Reduces relapses by 30-50% (National MS Society).
• Options: Injectable (interferons), oral (fingolimod), or infusions (ocrelizumab).

Build a Care Team:

• Neurologist, physical therapist, occupational therapist, and mental health counselor.

Lifestyle Adjustments:

• Exercise: Low-impact activities (yoga, swimming) to maintain mobility.
• Diet: Anti-inflammatory foods (omega-3s, leafy greens). A simple way to start is by adding superfoods to supercharge your health.
• Stress management: Mindfulness or meditation to reduce flare-ups.

Join Clinical Trials:

• Investigational therapies like remyelination drugs are in Phase 3 trials.

Living Well with MS: Practical Tips

Fitness Adaptations

• Modify workouts: Use resistance bands instead of weights if grip strength is weak. Also make sure you do proper warmup before a workout.
• Cooling vests: Prevent overheating during exercise (common MS trigger).

Workplace Accommodations
Request ergonomic chairs, flexible hours, or remote work under the ADA.

Diagnostic Test Reliability

Test Type	Percentage of MS Patients with Abnormal Results
Brain MRI	70-95%
Visual Evoked Responses	50-90%
Somatosensory Evoked Potentials	50%

FAQs About MS Diagnosis

Can MS be diagnosed with one MRI?
No—two or more lesions in different CNS regions and evidence of new damage over time are required.

How long does diagnosis take?
Typically 3–6 months, but varies based on symptom progression.

Is MS fatal?

Most patients have a normal lifespan. Severe cases may reduce life expectancy by 7–14 years. In order to ensure a healthy lifestyle, you can make some adjustments. For example; stop eating refined sugar. A healthy diet can reduce cancer risk. 

The truth about diet pills and diet programs is that they might not always be the best solution. Also there are ways to increase your life expectancy. 

You can even start by tracking your fitness and nutrition journal. By taking full responsibility for your mental and physical condition, you can live a longer and healthier life.

I hope this revised version is helpful!

References

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC2824949/

[2] https://onlinelibrary.wiley.com/doi/full/10.1002/ana.1032

[3] https://theneurologyhub.com/article/a-practical-guide-to-diagnosing-undiagnosing-multiple-sclerosis

[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC6278620/

[5] https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274

[6] https://mstrust.org.uk/a-z/mcdonald-criteria

[7] https://www.ti.ubc.ca/2023/09/05/multiple-sclerosis-diagnostic-criteria/

[8] https://www.healthline.com/health/progressing-ms/ms-progression-chart

[9] https://www.ncbi.nlm.nih.gov/books/NBK499849/table/article-25363.table0/?report=objectonly

[10] https://ms-uk.org/diagnosis-of-multiple-sclerosis-choices-booklet/

[11] https://www.aafp.org/pubs/afp/issues/2004/1115/p1935.html

[12] https://emedicine.medscape.com/article/1146199-workup

[13] https://www1.racgp.org.au/ajgp/2022/april/multiple-sclerosis-diagnosis-therapy-and-prognosis

[14] https://www.mdcalc.com/calc/2198/revised-mcdonald-criteria-multiple-sclerosis-diagnosis

[15] https://www.racgp.org.au/getattachment/e07c440f-e334-47c3-b817-b6cbb517a902/Multiple-sclerosis-diagnosis-management-and-progno.aspx

[16] https://www.polradiol.com/The-diagnosis-of-multiple-sclerosis-what-has-changed-in-diagnostic-criteria-,175241,0,2.html