In general, a neurologist with a special interest in multiple sclerosis makes the diagnosis of multiple sclerosis (MS). Certainly, these specialists see most cases and diagnose MS most accurately. To emphasize, there is quite a number of other neurological diseases that need to be excluded. Among these are for instance: Amyotrophic lateral sclerosis, Lyme disease, syringomyelia, systemic lupus erythematosus, hereditary ataxias, syphilis and many others.
By all means, the diagnosis hinges on a good history and a thorough neurological examination. Another key point is that some blood laboratory tests and some imaging tests complement the establishment of the diagnosis.
MRI scan to locate MS lesions
Surely, often the clinical course will tell the neurologist exactly where the demyelination lesions are located. Indeed, an MRI scan with or without Gadolinium-contrast enhancement confirms the diagnosis. Also special CT scans with a double dose iodine contrast material and delayed films (called double-dose delayed CT scan) make multiple sclerosis lesions visible with these imaging techniques. Truly, the MS MRI is the standard diagnostic test for pinpointing MS lesions.
Here is a link to a site where MRI scan images are shown where a demyelinated MS lesion can be clearly seen (scroll halfway down).
Other electrophysiological tests called “evoked potential tests” document the interference of the electrical impulse traveling along the sensitive pathways and being interrupted by the demyelination process. All of these various elements of testing and examining will tell the neurologist the correct diagnosis (Ref. 1-3).
Despite the overall depressing litany of possible symptom presentation, the life expectancy for most patients is not diminished.
Most people learn to live with their disability and function well for decades. Also, most people have only a few of the symptoms mentioned above and never get the full array that only a minority would get.
Remissions in the beginning can last more than 10 years. On the other hand, some patients have frequent attacks and these are the ones that likely have more lesions and have a poor prognosis. Men who get the first attack in middle age appear to be deteriorating more rapidly. Care needs to be taken not to get exposed to heat as mentioned above (avoid hot tub, fever, hot climate).
1. Z Liu et al. J Neuroimmunol 2001 Jan 1;112(1-2): 153-162.
2. C Liu et al J Neurol Sci 2000 Dec. 1; 181(1-2): 33-37.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 180.
4. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
5. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier