Diagnosing multiple sclerosis (MS) can take time because symptoms often look like those of other health conditions. Your healthcare provider takes a detailed medical history and does a neurologic exam to understand your symptoms.
They will ask whether you have relapses (attacks) and periods of remission, which are when your symptoms go away. They will also check your vision, reflexes and your walking style.
Symptoms
Symptoms vary from person to person and depend on which part of the central nervous system is affected. Inflammation attacks the sheath that protects nerve cells called myelin, causing it to degenerate. This results in problems with balance and movement (like trouble walking), vision, hearing and memory. Pain, fatigue and depression are also common. The symptoms can come and go, depending on whether you are having a flare or relapse.
A neurologist will examine you and discuss your symptoms to find out if they are related to MS or another health problem. They will ask about your past medical history and perform a physical exam. They may also order an MRI, cerebrospinal fluid analysis and blood tests to rule out other conditions with similar symptoms.
If you have the relapsing-remitting type of MS, new symptoms will develop as the result of an attack on your myelin sheath. These will probably last for a short time and then improve, remain the same or disappear during a period of recovery, known as remission. The neurologist will decide if your symptoms meet the long-established criteria for an MS diagnosis, including a pattern of symptom attacks and periods of recovery.
The first symptoms of MS often include weakness or numbness in your arms and legs. You might have trouble moving them or experience spasms that feel like a tight band squeezing around your body, called the MS hug. This sensation is usually the first sign of a relapse or MS attack and can be one of the worst symptoms of the disease.
Other early symptoms can include vision problems, like blurry or faded vision, or blind spots that move when you look from side to side. Other sight issues you might have are double vision or eye tremors, called nystagmus. You might also have problems with your bladder or bowel, like trouble urinating or feeling the need to urinate frequently. You might also have problems with swallowing, as the nerve damage that affects parts of your brain that control the muscles in your mouth and throat can cause a lack of coordination and lead to choking.
Diagnosis
The symptoms of multiple sclerosis are unpredictable and varied, and they can affect different parts of the body. The disease is caused by damage to the protective covering (myelin sheath) of nerve cells in your brain and spinal cord. This damage is caused by inflammation, which slows down or stops the transmission of nerve signals. It can also cause your immune system to attack the nerves in your central nervous system. Your neurologist will diagnose MS after taking a careful medical history and doing a physical examination. They will ask about your family history and previous illnesses to check for genetic vulnerabilities. They may use a magnetic resonance imaging (MRI) scan to look for the characteristic lesions of MS. They can be spotted with the aid of a special dye that is injected into a vein before the scan. They can also examine your eyes, hand and foot strength, balance and coordination, speech and reflexes to see if they have been affected.
If you are diagnosed with relapsing remitting MS, your symptoms will go through periods of worsening, called relapses, and then recover, partially or completely. About 85% of people with MS have this form of the disease. The other type is progressive MS, which gradually gets worse over time. You will likely need to visit your neurologist more often if you have progressive MS.
There is no single test to prove you have MS, but your neurologist will be able to confirm it from your medical history and the results of your physical exam and MRI scans. They will look for evidence of nerve damage to the brain and spinal cord, such as MRI lesions and a history of flare-ups. They will also rule out other conditions that can mimic the symptoms of MS.
Your neurologist will likely prescribe drugs that reduce the inflammation in your nervous system and help control your symptoms. These medications can also reduce the risk of relapses and slow down the progression of MS. Some of these medications have side effects that you should talk to your neurologist about before starting treatment.
Treatment
There’s no cure for multiple sclerosis (MS) — but treatments can reduce symptoms and relapses, and slow the progression of disability in people with MS. Treatment options include specialized medications, exercise, surgery and rehabilitation therapy.
The first step is to see your doctor or a health care provider who treats conditions that affect the brain and nervous system, such as a neurologist. Your neurologist will ask you about your symptoms and do a physical exam. They may recommend a magnetic resonance imaging scan (MRI) or cerebrospinal fluid analysis to look for scarring and plaques in the brain and spinal cord. They’ll also check for key signs of nerve damage, such as changes in vision, hand or leg weakness, balance and coordination, and difficulty speaking and walking.
It can be difficult to diagnose MS because the disease’s symptoms are very similar to many other conditions. Your healthcare provider will use the long-established McDonald criteria to rule out other diseases that cause similar symptoms. This involves a thorough medical history, a neurological exam and tests such as an MRI, cerebrospinal fluid analysis and evoked potentials.
These tests measure the electrical response of the brain to visual, sound and sensory stimulation by placing electrodes on your scalp or elsewhere on the body and sending painless electric signals to the nervous system. The results are used to show whether nerves can send and receive messages quickly and accurately.
Symptoms of MS vary from person to person and depend on where in the brain and spinal cord the nerve fibres are damaged. They can range from mild to severe, and they can come and go or last for a long time.
The disease-modifying therapies (DMTs) available can help reduce relapse rates, stop new attacks and delay the progress of disability in relapsing remitting MS. They can also slow the progression of disability in primary progressive MS, which has no relapses or MRI activity, and in some types of secondary progressive MS.
The most common DMTs are corticosteroids, which reduce nerve inflammation. Other treatments include muscle relaxants such as baclofen and tizanidine; botulinum toxin products such as Dysport (onabotulinum A) and Botox (abobotulinum A); surgery for spasticity; and rehabilitation techniques such as exercise, physical therapy and specialized seating and wheelchairs.
Support
There are many different resources available to support you and your loved ones after you’ve received your diagnosis. This might include talking to a therapist or counsellor who specialises in this area, as well as joining an MS support group where you can discuss your concerns with others who are going through the same thing. These groups can be found through local hospitals, community health centres, and advocacy organisations.
There’s no cure for MS, but it is possible to slow down the progression of symptoms over time. This can be achieved by following a healthy diet, regular exercise, and avoiding smoking and stress. If you’re experiencing new and unusual symptoms, let your GP know as soon as possible. They’ll be able to arrange for you to see a doctor who specialises in conditions of the nervous system (neurologist). It can often feel like an emergency when you experience new and unfamiliar symptoms, but they are rarely life-threatening.
Once you’ve been diagnosed, your neurologist can help you decide which treatment plan is best for you. This might involve drugs, lifestyle changes, and physiotherapy. It’s important to keep in touch with your neurologist and MS nurse so they can check for any new symptoms or signs of a relapse. It’s also important to make sure you attend appointments as scheduled, as this will allow for your condition to be monitored and treated if necessary.
If you haven’t already, it’s a good idea to tell your close friends and family about your diagnosis. It’s up to you who you tell and when, though, as symptoms can come and go. Initially it may be difficult to know whether you’re tired because of MS or just because of normal daily living. This can be made clearer with time, and it’s useful to avoid comparing yourself to people who don’t have MS.
It’s important to stay positive and get as much information about MS as possible, so you can ask the right questions of your doctor. This can be done by attending seminars, getting involved in research, or reading online. It’s also helpful to connect with other people who have MS, as they will understand the disease better than most other people.
