As yet, there is no one definitive diagnostic test for multiple sclerosis. The scattered symptoms you might have experienced over the months or years may easily have resembled other conditions, and a doctor cannot make a definite diagnosis of MS until other diseases and conditions are ruled out. MS is diagnosed only after signs and symptoms in at least two separate areas of the central nervous system (CNS) are found at two different times.
To diagnose multiple sclerosis, the doctor -- who may be a general practitioner or a neurologist -- will take a detailed medical history and do a neurological examination. The doctor will test reflexes and sensations, look at eye movements, watch a person's gait and coordination. Depending upon what is found, he or she may decide to order some additional tests. These may be done to rule out other diseases and/or confirm a diagnosis of MS.
Because some doctors do not want to alarm you without reason, they may not discuss the possibility of multiple sclerosis and suggest that symptoms of blurred or double vision, tingling, dizziness, loss of coordination, or numbness may be due to a post-viral infection or "just nerves". In some instances people have been referred to psychiatrists for a psychological assessment. Because many of the above symptoms occur in other conditions, not all people who report them have MS. However, anyone who knows they are unwell, is understandably frustrated when not given a definitive diagnosis.
"I resented the fact that my doctors had never really come clean and told me what I had. It was a relief to have the name even though I found it out indirectly through a hospital admissions slip."
For many people, the diagnosis of multiple sclerosis is a severe shock. Reaction to shock can be severe anxiety, anger, and tears. These emotions are very natural and normal. You may wish to discuss your feelings with your doctor, family members, friends, clergy, or support counsellors at the Multiple Sclerosis Society of Canada. Getting your feelings and fears out into the open will help you come to terms with the diagnosis. You may also wish to read Doctor-Patient Dilemmas in Multiple Sclerosis, an article by a doctor who has MS, which explores some of the problems that arise at the time of diagnosis. It is available from the MS Society
How is MS Diagnosed?.
The diagnosis of MS is based on a clinical history and examination. These procedures will show signs of several lesions in the brain or spinal cord over time. Your neurologist will order tests that will help back up the diagnosis. Usually a magnetic resonance imaging scan (MRI) of the brain (and possibly the spinal cord) is ordered to find proof of abnormal areas. Lumbar puncture, also called a “spinal tap,” is helpful to find problems with the cerebrospinal fluid. Computer assisted tests called “evoked responses” may also be used to help in diagnosis.
At this time, no single test is available to identify or rule out MS. Several tests and procedures are needed. Clinical Exam Includes History and Tests of Function. These are likely to include:
Complete Medical History
During the clinical examination, the physician takes a careful history to identify any past events that might be indicative MS-related disease activity, and performs a variety of tests. These tests evaluate mental, emotional, and language functions, movement and coordination, vision, balance, and the functions of the five senses. Sex, birthplace, family history, and age of the person when symptoms first began are also taken into consideration.
Healthcare providers need an overall view of the individual's health picture, including symptoms and when they began.