Why is Diagnosing MS so Complicated?
Getting a correct diagnosis is essential for starting the process of caring for your multiple sclerosis. If only it was a clear, easy journey. The majority of people who have MS can tell stories of strange symptoms that their primary doctors couldn’t understand or simply wrote off as “stress-related.” I know that my own diagnosis took almost 7 years for my case to be considered “definite MS”, despite obvious multiple signs. (My personal journey of frustration and confusion is the basis for this MS website.)
Oftentimes, unless a first attack is severe (such as one affecting vision or causing substantial paralysis of a limb or limbs), multiple sclerosis symptoms can mimic those of other diseases or conditions, such as lupus, Lyme disease, or fibromyalgia, to name a few. Add to this the fact that multiple sclerosis attacks can cause sudden symptoms that then disappear, and it’s easy to see why diagnosing it is often a lengthy, confusing process.
The following are methods that doctors use to diagnose MS, and usually 2 or more criteria are needed to make a definite diagnosis:
Diagnosing MS by Patient Symptoms
In the best case scenario, a patient’s primary doctor will refer her or him to a neurologist, a specialist who deals with the central nervous system (the brain and spinal cord and their nerves) and the peripheral nervous system (distant nerves). This may happen if a patient presents with neurological symptoms such as tingling (pins and needles), numbness, burning feelings, and/or vibrating sensations in one or more limbs or the torso. These are very common symptoms of an early multiple sclerosis attack. Other early symptoms of MS include optic neuritis (which causes optic nerve inflammation and subsequent vision impairment or temporary blindness in the affected eye), double vision, and limb or overall bodily weakness.
A neurologist assesses these symptoms as a basis for possible MS, since these symptoms are usually how multiple sclerosis is first suspected.
Diagnosing MS with Magnetic Resonance Imaging (MRIs)
Once physical symptoms look suspicious for multiple sclerosis, a neurologist might send a patient for MRIs. These tests, which operate with high-field magnets, are used to view the brain and parts of the spinal cord, where MS attacks and subsequent damage occur.
If MS lesions or scars, areas where nerve coverings are damaged, can be seen on the MRIs, this is another criteria to diagnose possible MS. Such scars are particular to MS and can rule out other conditions that mimic it.
Diagnosing MS with a Lumbar Puncture (Spinal Tap)
Another definitive multiple sclerosis test is the lumbar puncture, which draws spinal fluid from the spinal column. This fluid is then tested to rule out Lyme disease, meningitis, syphilis, and other neurological illnesses. Neurologists look for a certain element, something referred to as oligoclonal bands, present in the spinal fluid. Roughly 80 – 90% of MS patients have this present in their spinal tap fluid (Mult-sclerosis.org).
On a similar subject, MS cannot be diagnosed through bloodwork, but several other conditions/illnesses such as lupus, Epstein-Barr syndrome, and Lyme disease can be ruled out.
Diagnosing MS by the Presence of a Family History
Multiple sclerosis has not clearly been proven to be hereditary, but there seem to be patterns of the disease in some families. Because this is not a definite criteria to determine MS in and of itself, it might only be used as further evidence if the above-mentioned criteria points to multiple sclerosis and a patient does have a close family member or members with the disease.
Why is Proper and Early MS Diagnosis so Important?
If you suspect you might have multiple sclerosis, your best bet is to push, push, push for an evaluation with a neurologist, especially one who is considered an MS specialist. Many primary doctors don’t have the background to know subtle multiple sclerosis signs, such as general fatigue or weakness or even mild numbness that lasts for a week or so and disappears. If your insurance doesn’t require a referral to see a specialist, don’t wait for your primary doctor’s suggestion: make an appointment with the neurologist yourself. If you need a referral and your primary doesn’t think you need to see a neurologist, you might want to consider finding a new doctor.
The reason I am so emphatic about early and proper diagnosis is that there are various disease-modifying medications available today that weren’t around before the 1990’s. Early diagnosis and the start of one of these medications can drastically change the course of many people’s multiple sclerosis disease courses. Everyone responds differently to medication, but many patients have positive results and can prolong periods between attacks and have milder attacks when they do happen. There is currently no cure for MS, but the available medications can slow disease progression and possible disability.
