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ALL ABOUT MS Diagnosis of the disease (Part 7)

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Diagnosis of the disease

MS is not easy to diagnose. There is no specific test that could be diagnosed unambiguously, as there is no symptom that is specifically characteristic of that disease, or that only occurs therein. Diagnosis of MS must begin with a detailed history of the disease, followed by a complete physical examination, not only neurological, but also all other somatic systems. It is necessary to make certain laboratory tests to exclude possible other causes of symptoms.

In addition, in order to diagnose MS, it is necessary, in the case of a relapse-remitent form, that there are at least two neurological disorders that reflect the demyelination period separated by a period of at least 30 days. Or, in the case of a primarily progressive form, there must be a slow progression of symptoms over a period of at least 6 months.
Diagnosis of MS can be set only on the basis of clinical data and physical examination, but usually, for the diagnosis and initiation of therapy, additional methods are used in diagnostics. These are magnetic resonance (MRI) of the brain and spinal cord, evoked brain potentials, and analysis of cerebrospinal fluid.

Magnetic resonance is a widely used method in diagnosing MS. In the MRI, the demyelinating area in the brain and spinal cord is seen as a white spot. The magnetic resonance of the lower parts of the spinal cord (thoracic and lumbar spine) is rarely done because it often does not produce good results, because its interpretation is difficult due to numerous artifacts. This non-invasive method can track the progression of the disease in detail.

It should be pointed out that MS diagnosis can not be established solely on the basis of MRI, as its results can often refer to other diseases of the central nervous system.
Evoked potentials measure the electrical activity of certain regions of the brain in response to the stimulation of certain groups of nerves. This method is used as an ancillary diagnostic tool and allows demyelination to be detected which otherwise would not be possible to observe. In our conditions, the visual, auditory and sensory potentials are most often used to assess the passage of electrical impulses through appropriate functional paths.



In the analysis of cerebrospinal fluid, there are data on the existence of chronic inflammation of the central nervous system. Cerebrospinal fluid is tested for the existence of oligoclonal bands representing immunoglobulins found in 90-95% of people with MS (but also in persons with some other disorders) and a sign of the existence of an immune response within the central nervous system. Together with MRI and clinical data, the presence of oligoclonal tape helps to definitively diagnose MS. The cerebrospinal fluid is obtained by the lumbar puncture procedure. The analysis of cerebrospinal fluid also helps to exclude the possibility of some viral infection and other diseases that cause neurological symptoms similar to MS.
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