How is MS diagnosed – and how do those affected deal with it? (Video)
Multiple sclerosis (MS) is an autoimmune disease in which parts of the central nervous system are gradually attacked and damaged by the immune system. MS is sometimes called the disease with a thousand faces because it manifests itself in many people with very different symptoms. So how can MS be diagnosed? In the article we describe the procedure. But first: many sufferers are initially unsettled or anxious by the diagnosis - they feel helpless and lost control. In order to better cope with the stress and develop strategies for dealing with it, psychological support is recommended. In the video, our expert, psychotherapist Sally Schulze, explains how those affected deal with the diagnosis - and how therapeutic support can help.
What are the first signs of MS?
Since MS can affect different areas of the nervous system, very different early symptoms appear accordingly. The most common are sensory disturbances in the arms or legs. This can be a feeling of numbness or an unusual tingling sensation and can range up to coordination problems or spasmodic paralysis. Visual disturbances, usually only in one eye, are also among the most common early signs of MS. Other signs can be a decrease in attention, concentration or memory. The feeling of being constantly exhausted and becoming unnaturally exhausted quickly, known as fatigue, is one of the most common early symptoms. Bladder or bowel problems are also frequently described.
Diagnosis of MS by the neurologist
These symptoms can be caused by a variety of different diseases. The MS diagnosis is therefore often a diagnosis of exclusion; that is, diseases that could also be responsible for the symptoms must be ruled out. This is done primarily through a careful anamnesis, i.e. a review of the patient's previous medical history, by the family doctor or neurologist. Any information that the doctor receives, no matter how insignificant it may seem, can help to create a clear picture of the patient's state of health. If MS is suspected, various neurological examinations follow. First, the physical condition is determined by testing coordination, fine motor skills, muscle strength, sensitivity and reflexes:
- Test of strength and fine motor skills: hand pressing, spreading fingers against resistance, flexion and extension of elbows and knees, attempts to hold arms and legs forward, reflexes - the side-by-side comparison is particularly important.
- Test of sensitivity: Examination of pain, temperature and deep sensitivity with pointed or blunt, warm or cold, soft or rough objects; also examination of deep sensitivity, position sense and vibration sensation through further exercises.
- Test of coordination ability: target movements, e.g. with the finger-nose test
- Balance test: Checking the gait with eyes closed, while balancing on an imaginary line, on tiptoes or on heels
Evoked Potentials – Determining Nerve Conduction Velocity
A patient undergoing an MRI scan.
MRI, CSF diagnostics and McDonald criteria
Another important test if MS is suspected is magnetic resonance imaging (MRI). MRI is an imaging diagnostic procedure, but without the damaging effects of X-rays. It can be used to detect disease-related changes in the nervous system. Special contrast agents can even make active inflammation in the brain or spinal cord visible. Cerebrospinal fluid diagnostics can also provide clues: a lumbar puncture is used to take cerebrospinal fluid from the spinal canal and examine it for certain protein patterns that are typical of MS. This looks for so-called oligoclonal bands (OCB), which arise due to increased antibody production. If the inflammation is limited to the central nervous system (as is the case with multiple sclerosis), these antibodies can only be detected in the cerebrospinal fluid, not in the blood. The cerebrospinal fluid can also be examined for germs in order to rule out diseases such as Lyme disease. With the help of cerebrospinal fluid diagnostics and MRI, the so-called McDonald criteria can be used to determine with great certainty whether MS is present, possible or not. The spatial and temporal distribution of the symptoms is examined. In order to reach a reliable result, this may require examinations over several months.
Early diagnosis promotes therapeutic measures
Only the sum of the different diagnostic procedures can reliably determine the presence of MS. Thanks to new and increasingly refined examination procedures, a reliable diagnosis can be made relatively quickly. This enables therapy measures to be started as early as possible against the disease with a thousand faces.
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