Multiple sclerosis is a lifelong disease. It is diagnosed by a specialist - a neurologist, with the cooperation of other doctors. Diagnosis requires taking a very thorough history from the patient and family members and then examining the patient. The next stage is to carry out further tests. Although the disease cannot be completely cured, it is possible to live with it and function normally.
Table of contents:
- Medical consultation
- Clinical examination
- Cerebrospinal fluid examination
- Evoked potentials (visual, auditory and somatosensory)
- Tests for antibodies against myelin proteins
- Optical tomography of the retina
Medical consultation
The neurologist will take a detailed history of the patient. It is very important to report any central nervous system (CNS) symptoms. Any information from the patient's next of kin will be helpful. It is a good idea to write down any worrying symptoms before coming to the doctor (visual problems, fatigue, muscle pains, coordination problems, sphincter dysfunction, distraction and others).
Theexamination of the neurological reflexes of the individual muscles that the doctor will carry out will help to exclude diseases other than S.
In the history, the patient should describe at least two episodes (deterioration and impairment of function or appearance of new symptoms) of the disease, lasting no less than 24 hours. The interval between them should not be less than 30 days. If only one episode occurs, additional investigations are required.
Clinical tests
The next step is to perform detailed clinical examinations. The McDonald criteria are used to assess the findings (spread of lesions over time and their multifocal nature). The most commonly performed investigations include: magnetic resonance imaging (MRI) of the brain and spinal cord.
In the early stages of the disease, lesions in the brain and spinal cord may be absent or invisible. However, this does not mean that we are healthy. They usually appear in the later stages of the disease. The lesions that can be seen on an MRI scan resemble diffuse bright spots of various sizes (areas of demyelination).
This is a safe and painless imaging method. It does not use harmful and dangerous radiation for the patient.
Any visible changes in the image may indicate a progressive process of nerve cell degradation, suggesting that we are dealing with S. If the image is not clear, further tests are performed.
Cerebrospinal fluid examination
This examination is performed in hospital under local anaesthesia. Cerebrospinal fluid is taken from the patient, after puncturing the space between the vertebrae, usually in the lumbar region. Elevated levels of characteristic proteins (immunoglobulin IgG) and the presence of oligoclonal bands (suggestive of ongoing inflammation) are found in the CSF of S patients. This examination is painful. After collection of the fluid, one must not rise or lie on one's back for one hour.
Evoked potentials (visual, auditory and somatosensory)
This examination is completely painless. Electrodes are placed on the patient's head to monitor the brain waves produced in response to visual, auditory and sensory stimuli. By means of this test, any interference/disruption in the conduction of nerve impulses through the nerves is demonstrated. The speed of the signal is measured. In the case of S, when demyelination has occurred, the transmission time of information is increased.
Tests for antibodies against myelin proteins
Myelin is the most important and essential component of nerve fibre sheaths. In S, myelin is damaged or completely destroyed. Antibody tests indicate the presence of characteristic immunoglobulins in the serum that are directed against myelin proteins.
One of the antibodies is an antibody against myelin basic protein (anti-MBP) and an antibody (anti-MOG). The concentration of these antibodies is very often correlated with subsequent exacerbations and remissions of patients with S.
Optical tomography of the retina
Optical tomography of the retina is one of the modern techniques for imaging the individual layers of the retina. The structure of the retina is very clearly visible, making confusion impossible. The examination is very detailed and completely painless. It shows all abnormalities and changes affecting the organ of vision in the course of S.