A person who has experienced at least two clinical attacks, and has clear-cut evidence of damage in at least two distinct brain areas, can be definitively diagnosed with MS, as that individual fulfills requirements for both dissemination in space and time.
The McDonald Criteria were based on detection of lesions generally using 1.5T magnet strength in noncortical regions of the brain and spinal cord. However, a large proportion of MS lesions are in the cortex67,68 and can be detected using double inversion recovery imaging.
Criteria for a diagnosis of MS
In order to make a diagnosis of MS, the physician must: Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND. Find evidence that the damage occurred at different points in time AND.
with two of the following: ≥1 T2-hyperintense lesions characteristic of multiple sclerosis in one or more of the following regions: periventricular, cortical or juxtacortical, or infratentorial. ≥2 T2-hyperintense lesions in the spinal cord. presence of CSF-specific oligoclonal bands.
The McDonald criteria for dissemination in time are fulfilled if one of the following is present in a patient with a clinically isolated syndrome or a characteristic MS attack: The development of an additional clinical attack, supported by objective clinical evidence, that is characteristic of multiple sclerosis.
MRI shows brain abnormalities in 90-95% of MS patients and spinal cord lesions in up to 75%, especially in elderly patients.
For the diagnosis of multiple sclerosis, there should be at least one typical multiple sclerosis lesion in at least two characteristic regions [periventricular (abutting the lateral ventricles), juxtacortical/cortical, infratentorial, spinal cord] to support dissemination in space (Thompson et al., 2018).
Recommended Brain MRI Protocol for MS
Based on its high sensitivity, sagittal 3D FLAIR acquisition is the core sequence for MS diagnosis and monitoring[10]. Pre-contrast T1-weighted sequences are not routinely needed because pre-contrast images rarely assist with interpretation of post-contrast hyperintensities.
Those symptoms include loss of vision in an eye, loss of power in an arm or leg or a rising sense of numbness in the legs. Other common symptoms associated with MS include spasms, fatigue, depression, incontinence issues, sexual dysfunction, and walking difficulties.
Magnetic resonance imaging (MRI)
MRI scans confirm a diagnosis in over 90 per cent of people with MS. To get the image of your brain and spinal cord you'll be asked to lie down and enter a small tunnel in the centre of the MRI scanner.
There is a new blood test that may monitor multiple sclerosis disease activity better in clinically stable patients. The test is called sNfL (serum neurofilament). It measures the breakdown of a certain part of neurons, which occurs when multiple sclerosis is attacking the nervous system.
These include fibromyalgia and vitamin B12 deficiency, muscular dystrophy (MD), amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), migraine, hypo-thyroidism, hypertension, Beçhets, Arnold-Chiari deformity, and mitochondrial disorders, although your neurologist can usually rule them out quite easily.
Relapsing-Remitting MS (RRMS)
The most common type of MS is called RRMS. It is defined by temporary periods called relapses, flare-ups or exacerbations, when new symptoms appear. Individuals with this MS type experience clearly defined attacks of worsening neurologic condition.
Inflammation in a myelinated portion of the nervous system is the mainstay of multiple sclerosis (MS). Elevation of inflammatory markers such as procalcitonin, ESR and hs-CRP is suspected to occur in MS patients.
Diagnosing MS
More than 90% of people with MS have scar tissue that shows up on an MRI scan. A spinal tap can check for abnormalities in the fluid that bathes the brain and spinal cord. Tests to look at electrical activity of nerves can also help with diagnosis.
One of the most important changes in the 2017 revised McDonald criteria is that oligoclonal bands can be taken as a substitute for DIT, and thus, can be used to establish the diagnosis of multiple sclerosis after the first clinical event and a single brain MRI (2, 45).
Feeling fatigued is one of the most common and troublesome symptoms of MS. It's often described as an overwhelming sense of exhaustion that means it can be a struggle to carry out even the simplest activities.
While the genetics governing MS risk are still not completely understood, some 200 genes are thought to possibly contribute — even in small ways — to MS development. The strongest genetic risk factor is a particular variant of the HLA-DRB1 gene, called HLA-DRB1*15:01.
The term benign MS is sometimes used to describe a version of relapsing remitting MS with very mild or no attacks separated by long periods with no symptoms.
The Role of CSF Analysis in MS Diagnosis
CSF evaluation is the most reliable investigation in differentiation of infectious and non-infectious inflammatory disorders of the CNS.
MRI: MRI is the best imaging technology to detect scarring or MS plaques in different parts of the central nervous system (CNS). This test can also distinguish old MS plaques from those that are currently active or new.
Your neurologist will look for abnormalities, changes or weakness in your vision, eye movements, hand or leg strength, balance and co-ordination, speech and reflexes. These may show whether your nerves are damaged in a way that might suggest MS.
Signs and Symptoms
Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Characteristics of the MS gait pattern
You may walk more slowly, with shorter steps. You may lack in confidence when you walk – leading to hesitation and stumbling. You might feel unsteady when turning or walking. You might find placing your foot on the ground difficult.
Sjogren's syndrome is an autoimmune disease that can mimic some of the symptoms of MS such as fatigue and joint pain.