The 4 common diagnostic tools used to prove or disprove MS – multiple sclerosis by clinical neurologists are:

1. A comprehensive patient medical history and neurological exam.
2. Magnetic resonance imaging of the neuroaxis.
3. Evoked Potentials testing
4. Analysis of the spinal fluid

One of the common questions about MS as posted at the Multiple Sclerosis Foundation is, How is multiple sclerosis diagnosed?:

There is no single test that can be used to definitively diagnose a person with MS. Diagnosis involves both clinical evidence (something that a doctor observes during a neurological examination, or learns from a patient’s history) and the results of certain tests, such as MRI, spinal tap, or evoked potentials.

1. Comprehensive Patient Medical History and Neurological Exam

Establishing a diagnosis of MS and managing the condition if found, is built upon creating a positive working patient-physician relationship. This includes patients working with their primary care physician, their clinical neurologist, other care team providers and their insurance carrier member services. Patients can optimize their neurological consultation by reading the article by the American Academy of Neurology, Preparing for an Office Visit in English |  Preparándose para una visita al consultorio.

According to the National MS Society one of the tools for making a diagnosis:

In many instances, medical history and neurologic exam provide enough evidence to meet the diagnostic criteria. Other tests are used to confirm the diagnosis or to identify other possible causes of the symptoms or neurological exam findings.

2. Magnetic Resonance Imaging Of The Neuroaxis

This is done to investigate, record, and document clinical endpoint information for the physician or clinical neurologist on the case to review. Multiple sclerosis is thought to be an auto-immune disease but a neurological diagnosis as well as a diagnosis or recordation of inflammation in the central nervous system.

As published in the American Journal of Neuroradiology, Revised Recommendations of the Consortium of MS Centers Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-Up of Multiple Sclerosis (2016 Mar; 37(3): 394–401.):

A brain MR imaging with and without gadolinium is recommended for patients suspected of having MS or with an established diagnosis of MS who are new to a clinical practice and do not have recent imaging available for review. A cervical cord MR imaging at the same time would be advantageous in the diagnostic evaluation of patients with or without transverse myelitis and would reduce the number of patients requiring a subsequent MR imaging appointment.

Inflammation is recorded by utilizing magnetic resonance imaging (MRI) of the neuroaxis. The MRI of the neuroaxis consists of imaging the brain, cervical spine, and thoracic spine. Imaging generally starts with the MRI of the brain. The MRI for the diagnosis of multiple sclerosis is the defining standard diagnostic tool. However, in some cases testing may also include imaging the rest of the neuroaxis as clinically indicated.

In reviewing the MRI of the brain scan results, the clinical neurologist is looking for inflammation on the scan. Inflammation can be visualized as lesions or “spots” on the MRI brain scan. MRI scans with contrast enhancing agent, Gadolinium, make the spots appear white in color.

In some cases, sagittal FLAIR image sequence is performed with the MRI bran scan. This specific sequence allows the clinical neurologist to see the formation of the inflammation of the fiber tracks going in the perivascular spaces from the veinals from the corpus callosum radiating from the white matter. This is called a Dawson Fingers and is a technological diagnosis of multiple sclerosis.

The clinical neurologist works with the radiologist interpreting the scan. The reading radiologist is a physician who reads and interprets the MRI brain scan results. This may also be a radiologist with a subspecialty in neuroradiology. The reading radiologist’s interpretation of the scan is documented on the MRI of the brain scan report. If the brain scan is consistent with multiple sclerosis, then the radiologist will usually document it as a differential diagnosis. The radiologist doesn’t provide a diagnosis. A formal diagnosis is usually provided by the patient’s treating physician or the clinical neurologist on the case. The treating physician or the neurologist would generally provide clinical correlation with the findings.

If the reading radiologist interpreting the MRI brain scan does not see something which is consistent with MS, which is based on location, based on shape, based on orientation, as well as based on presentation, it would be difficult for the clinical neurologist to consider the MS diagnosis.

3. Evoked Potentials testing

Evoked potentials studies measure electrical activity in the brain in response to stimulation. Learn more about Evoked Potentials Studies.

According to AANEM, published in Muscle & Nerve in 1999:

SEP abnormalities, reflecting pathology in the brain or spinal cord, are present in up to 90% of patients with definite multiple sclerosis (MS) and in approximately 50% of MS patients without current sensory signs or symptoms. Reference: Somatosensory Evoked Potentials: Clinical Uses

4. Analysis of the spinal fluid

When the radiological diagnosis of MS is not shown, then the next option may be to consider spinal fluid testing. This is investigated by analyzing the spinal fluid.

As reported in the study, Multiple sclerosis, inflammation in the brain, and mood (Karceski S.):

When inflammation occurs in the brain, these molecules can be measured in the liquid that surrounds the brain (called cerebrospinal fluid or CSF).

The lumbar spinal tap procedure comprises of withdrawing a sample of the spinal fluid for analysis. This analysis will look for any inflammatory findings. The treating physician or neurologist will clinically correlate the spinal fluid analysis, the MRI brain scan, and any additional diagnostic tools, such as evoked potentials in the attempt to prove or disprove the diagnosis of MS.

> Learn more about MS

Research and Use of Biomarkers in MS

Research is currently being done to identify biomarkers for various conditions and diseases, including MS.

In an interview with Mirjana Maletic-Savatic, M.D., Ph.D., Assistant Professor, Department of Pediatrics

Neurological Research Institute:

When we talk about biomarkers, we’re referring to telltale biological signals that indicate the presence of a particular molecule associated with a disease or condition. (Elevated blood sugar levels, for example, is a biomarker for diabetes). Currently, we are limited by the tools that we have. To detect certain conditions and disease, we can perform behavioral assessments, neurological exams, and other tests, but what we really need in so many aspects of clinical neurology are reliable biomarkers.

In a 2009 animal study, MPO Imaging (MRI technique) is looking at the biomarker Myeloperoxidaseotential (MPO) a biomarker for disease severity in MS.

One of the study’s investigators reported:

Whatever the cause, we know MS is going to lead to inflammation, and inflammation in the brain releases MPO. Using this new imaging tool to monitor MPO levels noninvasively, we hope to be able to assess not just disease severity, but also treatment efficacy.

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