Why multiple sclerosis is difficult to diagnose
Some diseases and medical conditions are relatively easy to diagnose.
Some diseases and medical conditions are relatively easy to diagnose. Your doctor can do a rapid test to determine if you have strep throat, and see your broken arm using an X-ray. Unfortunately, multiple sclerosis (MS) is much more complex and can take months, or even longer, to accurately diagnosis. There is no single test that will tell you if you have MS. Doctors arrive at a diagnosis based on a combination of your symptoms and the results of several different tests.
“Symptoms of multiple sclerosis vary widely among patients, and even within the same patient over time,” said Douglas C. Nathanson, M.D., a neurologist at Geisinger Wyoming Valley Medical Center in Wilkes-Barre. “Even when the symptoms follow a classic pattern, they must meet certain guidelines before the doctor or neurologist can be sure its MS."
Multiple sclerosis is a common disease of the nervous system that affects 2.3 million people worldwide. It’s known as an “inflammatory demyelinating condition,” which means that the disease causes inflammation that damages myelin, the fatty material that insulates nerves.
“Think of myelin as the protective cover that wraps around an electrical wire,” said Dr. Nathanson. “When that covering is damaged, the electrical impulse traveling through that wire can’t reach its destination smoothly or efficiently. This is similar to what happens to nerves with MS.”
When myelin is damaged or stripped away, impulses traveling to and from the brain and the rest of the body are disrupted. These damaged areas are called lesions, and they cause the symptoms that people experience with MS.
The challenge of the diagnosis
While MS has some common symptoms, they often vary depending on where in the brain or central nervous system the lesions occur. These symptoms may include:
- Numbness and tingling
- Weakness throughout the body
- Sexual problems
- Walking problems
- Muscle spasms
- Vision problems
- Bladder and bowel problems
- Cognitive changes
- Emotional changes and depression
“No two people with MS will have exactly the same symptoms, and many of these symptoms may have other causes,” said Dr. Nathanson. “A big part of the MS diagnosis is ruling out other diseases and conditions that may cause the same symptoms.”
The other diseases and conditions that need to be ruled out are numerous, including Lyme disease, migraine headaches, lupus, stroke, fibromyalgia, several inflammatory autoimmune diseases, and even vitamin B12 deficiencies.
The three tests to diagnose MS
“Based on your history and neurological exam, there may be enough evidence to warrant more testing for MS,” said Dr. Nathanson. “There are three tests that can help confirm the diagnosis.”
These three tests include:
- Magnetic Resonance Imaging (MRI): The MRI is a test that creates a picture of your brain using a magnetic field and pulses of radio wave energy. The doctor uses this test to find the hallmark lesions or plaques created by MS.
- Lumbar puncture: This test is also called a spinal tap and it’s used to examine cerebrospinal fluid – the fluid the surrounds the brain and spinal cord – to look for proteins and antibodies characteristic of MS.
- Evoked potential test: This test measures how long it takes nerves in different areas of the body to respond to a stimulus by measuring your brain waves. Common areas for testing are vision, hearing, and feeling in your arms and legs.
“A combination of the results from these tests, your symptoms and medical history will help with your ultimate diagnosis,” said Dr. Nathanson. “As hard as it will be, stay patient and maintain hope, since a proper diagnosis will be the first step in managing your disease.”
Douglas C. Nathanson, M.D., specializes in the care of patients with multiple sclerosis. To schedule an appointment, please call 1-800-275-6401 or visit Geisinger.org.