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Diagnosing MS

No single test can diagnose MS. The medical history, neurologic exam and lab tests help healthcare providers rule out other diseases and confirm the MS diagnosis.

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In this article

Overview

At this time, there are no symptoms, physical findings or laboratory tests that can, by themselves, determine if you have MS. Several strategies are used to determine if you meet the long-established criteria for a diagnosis of MS, 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), spinal fluid analysis, and blood tests to rule out other conditions.

Timely and accurate diagnosis

There are many possible causes of neurological symptoms. When MS is considered as a potential diagnosis, other causes must be excluded — through the tools and tests outlined below — before an MS diagnosis is considered definitive. While this process of exclusion may be quick for some, it can also take much longer, with repeat testing sometimes needed. 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 such as cancer.
  • 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 MS

At this time, there are no symptoms, physical findings or laboratory tests that can — by themselves — determine if you have MS. The doctor uses several strategies to determine if you meet the MS diagnostic criteria. In order to make a diagnosis of MS, 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 Revised 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

Tools for making a diagnosis

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 traveled that might provide further clues.
  • Performs a comprehensive neurologic exam, which includes tests of cranial nerves (vision, hearing, facial sensation, strength, swallowing), sensation, reflexes, coordination, walking and balance.

In many instances, medical history and 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.

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 erythematosis, Sjogren's, vitamin and mineral deficiencies, some infections, and rare hereditary diseases.

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