Multiple sclerosis is a difficult disease from the perspective of both patient and doctor. Diagnosing it takes a great deal of time and effort because there are stringent criteria to meet before that diagnosis is given. At the same time, living with the symptoms, especially without knowing for sure if MS is even the cause, can be terrifying.
Having a definitive answer can relieve a lot of stress for both the neurologist and the patient, since the diagnosis means moving away from fear of an even more detrimental disease and moving on to changing lifestyles and habits to better suit the needs of the patient without fear of relapse. There are a battery of tests that doctors can run, but one of the most crucial in the diagnosis of multiple sclerosis is an MRI, or magnetic resonance imaging test.
Why should MS be diagnosed early?
Multiple sclerosis is an autoimmune disease, but more importantly, in the end, it is typically progressive for most patients. Earlier detection of the disease can help prevent a lot of permanent damage and get patients on the right track to living a fuller, healthier life, and diagnosing in a timely manner also helps the patient relax stop worrying about other types of ailments that are possible factors. Other findings weigh in heavily, too, in the need to strip down to a diagnosis sooner.
- In the past, physicians believed that it took time for actual nerve damage to appear due to MS. However, it’s been verified now that, even in early stages of the disease, nerves can attain irreversible damage.
- In addition, projections of how common multiple sclerosis have been far off. In the last few months, doctors and scientists have determined that there are likely more than double the number of MS sufferers than previously thought. That means in the United States alone, projections have jumped from about 400,000 to over a million.
It almost seems like this could turn into an epidemic, and there is no cure, which means it’s even more vital to try to find these patients sooner so damage can be kept to a minimum.
Multiple sclerosis criteria for diagnosis
Why is so much testing required to evaluate and assure a patient has multiple sclerosis? There are several other diseases and conditions that also show similar symptoms, and it’s important to know for certain that someone has MS without ignoring other possibilities.
To give an assured diagnosis, doctors are required to find:
- Evidence of damage to the central nervous system, or CNS, in at least two areas, including the brain, spinal cord, and optic nerve;
- Evidence of the damage occurring during at least two different incidents at two different times (a single occurrence wouldn’t justify a diagnosis of MS, though the patient may still be diagnosed with CIS, or clinically isolated syndrome); and
- That there are no possible causes aside from MS for the combination of symptoms in question.
Testing to meet these three criteria would be carried out by a neurologist, a doctor that specializes in the study of the CNS. Several methods can be used to make identification of MS and its symptoms, with one of the most important being a magnetic resonance imaging test, or MRI.
What is an MRI?
Of all the available imaging resources for the brain and the spinal cord, the MRI is the most popular choice and used most often. Aside from being used in MS testing, it can help identify aneurysms, eye and inner ear disorders, injuries to the spinal cord, brain injuries, strokes, tumors, and other types of trauma experienced.
Because the MRI uses magnets to create the image, it’s dangerous for anyone with metal in their body, and patients are typically asked to remove any and all jewelry. To complete the test, the patient is placed in a large tube, which uses magnets to realign the hydrogen atoms in the patient’s body and then produces radio waves. These waves hit the atoms that have been aligned within the patient and create tiny signals. Those signals then create a 3D cross-sectional image – like slices through the bread – of the organs and tissues, including the brain and the matter inside the spinal column.
MRIs are noninvasive and give a very clear picture of nerves and nervous fibers within the body so that a neurologist can evaluate and look for potential inflammation around the nerves or damage to them.
An MRI doesn’t hurt, unless one of the risk factors is present, such as:
- Metal implants of any kind
- A metal prosthetic
- Bullet, shrapnel, or any other metal in the body
- Artificial valves to the heart
- A defibrillator implanted
- A pacemaker
- Cochlear ear implants
The MRI has been around for years and is perfectly safe, though a doctor should know if a patient could be pregnant, has tattoos with metal in the ink, or has severe issues with claustrophobia, since the MRI machine is tightly enclosed.
Unfortunately, doctors can’t rely only on MRIs to make a diagnosis, since a clear image of damage doesn’t necessarily mean that damage was caused by an immune system attack triggered based on MS.
The battery of tests for MS
Before starting any testing, invasive or otherwise, a neurologist usually asks a great many questions, like an inquisition, to learn more about the patient and get a well-rounded knowledge of medical history. The doctor may ask about:
- Symptom history, including how many times the symptoms have been experienced and how long they lasted.
- Medical history, family history, and place of birth or residence, as well as any information that could help pinpoint an environmental risk factor, including traveling, destinations, timing, and exposures.
- Particulars that revolve around noting loss of functionality in speech, emotion, or mental capacity.
- Issues with balance, walking, coordination, reflexes, strength or weakness, vision issues, other motor skills, various sensory capabilities, etc.
This may turn into a physical exam, testing some of the motor skills and reflexes. Then, aside from the MRI, a group of tests may be ordered.
- Evoked Potential – These test the sensory abilities of a patient with electrical signals are monitored and traced as they move through the central nervous system, or CNS, to determine whether or not they are signaling properly and moving at the right speed.
- Cerebrospinal Fluid – The doctor will perform a spinal tap, taking a sample of the fluid (CSF) to look for signs of MS, including antibodies produced for the attack on the nerves.
- OCT – An optical coherence tomography is a noninvasive way to pick up on damage to the retinal structure and optic nerves, including optic neuritis, which is common in patients with MS.
Using an MRI to assist in the diagnosis of a disease in which doctors have to determine that a patient meets a very specific set of criteria makes the job much easier for the physician, even though it remains a long and daunting process. As a patient, the wait is just as hard, and especially if symptoms are active, it can be brutal to go through the paces. But making that determination is essential to moving on and finding a good therapy regimen that works.