HOW IS MULTIPLE SCLEROSIS DIAGNOSED?
MS is usually diagnosed and treated by a neurologist, however other medical professionals who specialize in neurology in conjunction with another area of medicine, such as radiology (a neuro-radiologist), ophthalmology (a neuro-opthalmologist) and psychology (neuro-psychologist), often assist in diagnosis and subsequent treatment protocols.
Since the symptoms of early MS may come and go and they vary from person to person, the diagnosis of MS is complex and it requires a complete review of the patient’s medical history along with a physical exam and various tests. The review of the patient’s medical history and the symptoms will help the doctor with important information regarding the diagnosis of MS. Further, the doctor would also need to know about past treatments, current and ongoing medical conditions and history of family health issues.
Physical Examination:
While confirming a diagnosis of MS, the doctor would make the patient go through a physical examination that might reveal signs of MS such as irregular eye movement, changes in speech, coordination issues, sensory disturbances, changes in reflexes and weakness/ spasticity in the patient’s arms or legs.
Magnetic Resonance Imaging (MRI):
An MRI is the most common diagnostic tool as it can detect distinctive lesions or scars in the central nervous system that comprises the brain, spine and optic nerve. So, the medical history review, physical exam, and an MRI will help the neurologist and his/ her team make a diagnosis of MS, however, in some cases, the team might need additional tests to confirm the diagnosis, such as:
Magnetic Resonance Spectroscopy (MRS): MRS is a non-invasive, diagnostic test that’s used for measuring biochemical changes in the brain. It is used to compare the chemical composition of normal brain tissue with abnormal brain tissue.
Lumbar Puncture (Spinal Tap): In this procedure, a very thin needle is inserted at the base of the spine and a small amount of cerebrospinal fluid is collected. Since introduction of MRI, cerebrospinal fluid analysis is used less often, but it might help in confirming an MS diagnosis if the MRI results are inconclusive.
Evoked Potential (EP) Tests:EP Tests are used to measure the speed of the brain’s response to visual, auditory (sound), or sensory stimuli. Delayed responses can indi- cate possible damage to the nerve pathways.
Expanded Disability Status Scale (EDSS): This is method that quantifies disability in MS patients and is used to monitor changes in the level of disability over time. The EDSS ranges from 0 to 10 in increments of 0.5 and the scoring is done by a neurolo- gist post examination.
EDSS Steps 1.0 to 4.5 refer to people with MS who are able to walk without any aid and is based on measures of impairment in dierent Functional Systems (FS). And EDSS Steps 5.0 to 9.5 are defined by the impairment to walking.
A Functional System (FS) represents a network of neurons in the brain responsible for particular tasks such as moving limbs, coordinaton, sensation, speech, eye movement etc.. Each FS is scored on a scale of 0 (no disability) to 5 or 6 (more severe disability). The EDSS Score is important for an MS patient because an EDSS score of less than 7 is need to be eligible for a Haematopoietic Stem Cell Transplantation (HSCT).
To read more about EDSS Score description, click to expand table: