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Multiple Sclerosis Diagnosis & Evaluation

There is no single test that can diagnose MS. To make the diagnosis of MS, a high-quality, high-resolution brain MRI scan is critical as well as a thorough diagnostic approach based on the patient’s history of symptoms and neurological examination.

Neurologists at the MS Center use the most advanced technologies to diagnose multiple sclerosis and develop customized treatment plans. The evaluation process includes state-of-the-art imaging, spinal fluid evaluation, blood work and other neurological exams.

MRI Scanning — As a leading research center, the MS Clinic at Harper has two dedicated MRI machines, including a high-resolution, 3 Tesla MRI. The MRI of the brain and spinal cord are the most important tests because more than 90% of the patients who have MS also have changes on the MRI scan consistent with MS. Other useful tests to consider are the lumbar puncture (spinal tap) and evoked potentials. Blood tests and in some cases a chest CT scan are needed to rule out other diseases which can mimic MS, like lupus and sarcoidosis.

If both the brain and spinal cord MRIs are normal, the diagnosis of MS, although still possible, is very unlikely. In this instance, a lumbar puncture may be recommended. It may be necessary to examine the patient at frequent intervals and repeat MRI scans as needed.

The MRI scans utilize state-of-the-art techniques that quantify brain atrophy and myelin injury, which have important therapeutic and prognostic implications. These imaging techniques are processed in Dr. Khan’s laboratory.

Lumbar Puncture (Spinal Fluid Test) — MS Center specialists sometimes analyze spinal fluid as part of an MS evaluation. This is typically performed with a lumbar puncture (LP) procedure. LP is a relatively simple procedure that can be done in the doctor’s office in about 30 minutes. It involves giving local anesthesia in the lower back before inserting a small needle into the lower back to obtain a small amount of fluid. This fluid, called cerebrospinal fluid or CSF, bathes the spinal cord and the nerves coming out of it. Approximately 90 to 95% of MS patients have immune system abnormalities in the spinal fluid. These abnormalities can be seen in other disease as well and therefore, the doctor has to keep in mind the clinical “picture” when interpreting the result of the spinal fluid.

Evoked Potentials are tests that measure the brain’s response to certain types of stimulation. They are less sensitive tests than MRI and LP in diagnosing MS but may still be helpful in certain situations. Three kinds of EPs are used by Harper neurologists:

  • Visual evoked potentials (VEP) look for abnormalities in the visual system, particularly the optic nerves.
  • Brainstem auditory evoked potentials (BAEP) look for hearing abnormalities in the inner ear and the hearing centers in the brain.
  • Somatosensory evoked potentials (SSEP) look for abnormalities in the transmission of sensation from an arm or leg through the spinal cord to the brain.

Blood Work — A variety of disorders can mimic MS. When evaluating MS patients, blood work is often done to rule out many of these mimicking disorders.

Disorders with Symptoms Similar to MS
Several conditions can mimic symptoms of multiple sclerosis. To make the diagnosis of MS, a good quality, high-resolution brain MRI scan is critical as well as a thorough diagnostic approach. Some of the conditions that can mimic MS include:

  • CNS Lupus
  • CNS Sarcoidosis
  • Lyme disease
  • CNS Vasculitis
  • CNS viral infections
  • Childhood and adult leukodystrophies
Each of these should be carefully evaluated depending on the patient’s history and neurological examination. Not every single disease mimicking MS needs to be ruled out in every case.
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