Diagnosis Of Multiple Sclerosis

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[edit] Diagnosis Of Multiple Sclerosis

The diagnosis should be made by a neurologist with a special interest in multiple sclerosis. These specialists see most cases and diagnose it best. 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.

The diagnosis hinges on a good history and a thorough neurological examination. This is complemented by some blood laboratory tests and some imaging tests to establish the diagnosis.

Often the clinical course will tell the neurologist exactly where the demyelination lesions are located. This can be confirmed by an MRI scan with or without Gadolinium-contrast enhancement. 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.

Here is a an image of a brain from an MS patient with several demyelinated lesions seen as brightrer lesions among the background of the normal brain tissue.

Serial MRI scans in intervals of several months or years will show progression of the yellow lesions. The very small lesions will likely grow into larger ones on repeat testing unless it is treated aggressively.

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).

Prognosis:

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).

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References:

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, 7^th 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