How Is Multiple Sclerosis Diagnosed?

Multiple sclerosis (MS) is a disease that affects the nervous system, causing symptoms such as numbness, pain, fatigue, or memory problems, according to the National Multiple Sclerosis Society. MS is an autoimmune disease, which means that the immune system turns on itself and fights healthy cells in the body. Specifically, MS damages the myelin sheath that insulates the brain's nerve fibers and disturbs the brain's communication signals. 

The first course of MS is called clinically isolated syndrome (CIS), where someone develops symptoms of MS for at least 24 hours. This episode, also called an attack, is a result of inflammation and damage to the myelin sheath. Because MS can't be diagnosed with a single test or symptom, it involves several tests to confirm a diagnosis.

According to the National Health Service, a diagnosis of multiple sclerosis is typically not considered until you've had two separate attacks. Even if you might not have noticed one or both events, an MRI could also point out any damage to the myelin sheath. To confirm a multiple sclerosis diagnosis, a neurologist will check for anything atypical or any weaknesses in your vision, balance, speech, or reflexes. A lumbar puncture will draw a sample of spinal fluid to test for antibodies that would indicate any disease of the brain or spinal cord. A blood test could also be ordered to rule out any other conditions such as neuromyelitis optica.

Different types of multiple sclerosis

The National Multiple Sclerosis Society says there are four types, or courses, of MS

The first is CIS, which is characterized as being the first episode of MS. Someone with CIS could experience a variety of symptoms such as vertigo, bladder problems, weakness of the limbs on either side of the body, or loss of sensation in the face. Although many people might experience any of these symptoms, someone with CIS must have these symptoms for 24 hours as a result of the inflammation and breakdown of the myelin surrounding the brain's nerve fibers. People with CIS don't always develop MS.

The most common type of MS is relapsing-remitting MS (RRMS), representing about 85% of MS cases. People with RRMS might experience a relapse in symptoms for a while, but then there could be periods where the disease seems to be in remission. During these stages of relapse or remission, MS could be worsening or not worsening.

Secondary progressive MS (SPMS) will follow RRMS. In this course of MS, disabilities either stabilize or progress over time. 

Primary progressive MS (PPMS) is the fourth course of MS, where the disease worsens upon the onset of symptoms.

Treating multiple sclerosis

Although there is no cure for MS, certain treatments can help symptoms of the disease, according to the National Health Service. Steroid packs or injections could help with MS relapses. Regular exercise, quality sleep, and cognitive behavioral therapy (CBT) are treatments for MS-related fatigue. CBT can also assist with emotional issues related to MS. Your doctor might suggest antidepressants to help with emotional problems. People with MS might experience muscle spasms and stiffness, so physical therapy and stretching can manage these symptoms. Pain is also common with MS, so your doctor might prescribe certain medications or physical therapy to help.

The National Institute of Neurological Disorders and Stroke says certain medications can be used to reduce inflammation of MS. Beta interferon drugs are injectable medications that suppress the immune response that causes inflammation. Infusion treatments — such as natalizumab, which blocks immune cells from reaching the brain or spinal cord — can also target the immune system. Fingolimod is an oral treatment that keeps white blood cells in the lymph nodes rather than reaching the brain or spinal cord.

People with MS should consult with their doctors about a treatment plan that includes a healthy diet, exercise, and self-care plan. Because smoking can worsen MS, you should also consider a smoking cessation program.