Dr. Lindsey's Multiple Sclerosis Website

New diagnosis of MS
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This page has information for people who are recently diagnosed with MS or in the process of being diagnosed with MS.
The diagnosis of MS is sometimes obvious and sometimes a long process.  For most people, there is a period where the diagnosis is uncertain.  This can be frustrating.  I will explain how we make the diagnosis and review the usual laboratory tests that we use. 

To make the diagnosis of MS, you have to have multiple events in both time and space.  "Multiple events in time" means that you have to have either two relapses separated by a stable period of at least 30 days, or one clinical relapse and new lesions on MRI after a stable period of at least 30 days.  "Multiple events in space" means that two different parts of the brain or spinal cord were affected in the two events.  The "multiple" aspect helps separate multiple sclerosis from several related diseases with different treatments, but necessitates an observation period waiting for the second event for most people. 

The criteria for diagnosing MS are evolving, and are still based on multiple events as described above.  There is no single symptom, clinical finding, or laboratory test that will make the diagnosis or exclude the diagnosis.  The doctor has to put all the information together, and make their best judgment.

There are several tests that are useful in the diagnosis of MS.  The most useful test is MRI of the brain and sometimes spinal cord.  Usually, when someone has their first symptoms of MS there are already several white matter lesions on MRI of the brain.  If you repeat the MRI 3 to 6 months later, there are often new lesions which satisfy the criteria for multiple events in time.  

Another test which is often helpful is a lumbar puncture or spinal tap.  There is a particular type of protein, known as oligoclonal bands, which is present in about 90% of people with MS.  A second test, the IgG index, is usually elevated in MS also.  These two tests are helpful in confirming the diagnosis if positive, but are sometimes negative in people with MS.  

There are several other diseases which can cause problems similar to MS, and these have to be excluded.  Most of them are much less common than MS.  Most of them can be tested for with a simple blood test.  The diseases I usually exclude with blood tests are Vitamin B12 deficiency, sarcoid, Lyme disease, neurosyphilis, lupus, and Sjogren's.  Other diseases which have to be differentiated are optic neuritis, transverse myelitis, and inherited genetic diseases called leukodystrophies.  

When someone comes in with a symptom suggestive of MS, my usual procedure is to start with an MRI scan of the brain.  If this looks like MS, then next I do the blood tests to exclude other diseases with different treatments, and then the spinal fluid tests.  I repeat the MRI in 3 months to see if it shows new activity.  Whenever someone has a second clinical episode or a new finding on MRI which meets the criteria for diagnosis of MS, I start them on one of the preventive treatments.   Occasionally if someone has a very active looking MRI when they first come in, I will start them on treatment right away instead of waiting for the second episode.  

The reason we try to make the definitive diagnosis of MS as early as possible is that there are some partially effective preventive treatments available.  These treatments, interferon or glatiramer, can prevent some of the relapses and disability, and should be used early in disease since they prevent some problems but don't do anything for symptoms that are already there.  

One thing to remember is that having a diagnosis of MS doesn't tell you anything about how the disease is going to affect you.  Some people have MS, but have very little trouble with it.  Other people with MS have a lot of symptoms and problems.  I think we are picking up a lot of mild cases of MS because of the sensitivity of the MRI scan and the emphasis on early diagnosis, and most of my patients do very well on one of the available preventive treatments.    
 

J. William Lindsey, MD
University of Texas Multiple Sclerosis Research Group
Houston, Texas

copyright 2007-2017 John William Lindsey