Multiple sclerosis (MS) is a chronic disease of the central nervous system. The immune system inflames the myelin that encases the nerve fibers, the cells that make the myelin, and the nerve fibers themselves.

The symptoms of MS vary from person to person. Problems with vision, balance, coordination, and fatigue are among the most common symptoms.

According to a landmark study the National Multiple Sclerosis Society conducted in 2017, nearly 1 million adults in the United States have MS.

The symptoms of MS can be unpredictable, but doctors will typically look for the following:

  • dysesthesia, which is a more distinct MS symptom and feels like squeezing around the torso kind of like the tightening of a blood pressure cuff
  • fatigue
  • difficulties with the gait, such as limb weakness, balance problems, or sensory deficits
  • numbness on the face, arms, legs, or elsewhere on the body, which can show up as one of the earliest symptoms
  • spasticity, which describes involuntary muscle spasms that most commonly happen in the legs
  • vision problems, such as blurred vision, poor contrast, problems with seeing colors, neuromyelitis optica, optic neuritis, or pain in the eyes, which can often show up as the first symptoms as well
  • vertigo or feeling light-headed
  • problems with the bladder
  • sexual dysfunction
  • constipation
  • pain throughout the body
  • cognitive or emotional changes
  • depression

Less common symptoms may also include:

  • problems with your speech, hearing, or taste
  • dysphagia, which means difficulty swallowing
  • tremors
  • seizures
  • breathing problems

To reach the diagnosis of MS, your doctor must find:

  • damage in two distinct areas of the central nervous system
  • the areas of damage developed at two different points in time
  • all other possible diagnoses are ruled out

Generally, a series of tests are needed to meet the criteria for diagnosis. In addition to gathering symptom history and blood tests, your doctor might also order the following tests.

Blood tests

Blood tests are often an effective way to eliminate or confirm other diagnoses. Blood tests can help your doctor rule out other conditions that trigger some of the same symptoms as MS. This puts your doctor one step closer to making an accurate diagnosis.

Since symptoms come and go, and there isn’t one test that provides a conclusive diagnosis, it can take a long time to diagnose MS. While the wait may be frustrating, each test will help eliminate or confirm other potential causes for your symptoms.

MRI tests

An MRI is painless, non-invasive, and can produce detailed images. Performed both with and without contrast dye, an MRI can identify lesions on the brain and spinal cord. The images can show if the lesions are old, new, or currently active. In addition to diagnosis, an MRI can help monitor disease progression.

Spinal tap

Although lumbar puncture can’t rule out or confirm MS, it can help with diagnosis. Spinal fluid is obtained from a needle inserted between the bones of your lower spine.

In people with MS, the spinal fluid sometimes contains elevated levels of IgG antibodies or proteins called oligoclonal bands, which could also be caused by some other diseases. About 5 to 10 percent of people with MS have no spinal fluid irregularities.

Evoked potential tests

This test involves staring at a screen with an alternating checkerboard pattern.

This helps show how electrical activity in the brain responds to external stimulation such a sight or sound, and whether there’s any impairment of your optic nerve pathways.

There are different types of evoked potential (EP) tests. The visual evoked potentials (VEP) test is the most common.

Eye exam

For many people, vision problems may be the first signs of MS. This can present commonly as optic neuritis, which is an inflammation of the optic nerve that can cause vision to become blurred, colors to become dimmed, pain in the eyes, blind spots, and contrast sensitivity.

Other MS-related problems include double vision and involuntary eye movements. Anyone who presents with these kinds of symptoms should visit an ophthalmologist, neurologist, or neuro-ophthalmologist to determine whether the cause could be MS.

Low-vision specialists

In addition, if you are diagnosed with optic neuritis, and you continue to experience vision loss despite other treatments, you can also consult with a low-vision specialist — typically licensed doctors of ophthalmology or optometry — for a recommendation on support and strategies to help you live your best life with the level of vision that you have.

The doctor will thoroughly examine your eyesight specifically in terms of how it functions in your day-to-day life, which means this is a lengthy exam that lasts longer than a traditional eye exam.

They will also ask a lot of questions about your life. The visit may result in not only advice but also a prescription for an aide device such as an optical device that fits your needs.

A number of conditions can cause symptoms similar to those of MS. When doctors order blood tests, they can use them to look for MS by identifying clues to other conditions that can mimic the disease. These conditions include:

  • Lyme disease, which can cause tingling or numbness in your arms, hands, legs, and feet. These are also common symptoms of MS. While not 100 percent accurate, enzyme-linked immunosorbent assay and Western-blot blood tests can detect the presence of Lyme disease infection in the blood.
  • Systemic lupus erythematosus (SLE), the most common type of lupus, according to the Centers for Disease Control and Prevention, is an inflammatory autoimmune disease that can affect your central nervous system and may cause numbness, tingling, fatigue, and vision problems. A blood test that is positive for antinuclear antibodies and other antibodies may indicate lupus or some other autoimmune disease but not MS.
  • Neuromyelitis optica, better known as Devic’s disease, is a rare immunological disorder that is strikingly similar to MS. The two conditions share many symptoms such as blurred or lost vision, weakness, numbness, bladder problems, and spasticity. A test called the NMO-IgG blood test will be negative in people with MS but positive in 70 percent of people with Devic’s disease.

Vitamin deficiencies

People who have MS often have a deficiency in vitamin D, which may increase the risk of developing the disease.

A person gets 80 to 90 percent of their vitamin D from exposure to the sun and the rest from food. The dietary sources of Vitamin D are mainly fatty fish such as salmon or sardines, beef liver, cheese, and foods that are fortified with the vitamin such as milk.

Blood testing can show whether a person has vitamin D deficiency. Studies have shown that maintaining a good level of vitamin D may help reduce the risk of developing MS. For people who already have MS, increasing their vitamin D intake may help make symptoms less severe. However, the research on this is still not conclusive.

In addition, other deficiencies may cause symptoms that mimic those of MS. Doctors can also identify these by testing your blood. They include:

  • Demyelination. Demyelination, which is common in both B12 deficiency and MS, is damage to the protective covering that surrounds nerve fibers within the central nervous system. Symptoms of vitamin B12 deficiency include numbness and tingling in the hands and feet, weakness, and fatigue. Blood tests would indicate a B12 deficiency, but it is very difficult to distinguish between a general deficiency and one that’s associated with MS.
  • Zinc. A doctor can also detect a zinc deficiency through a general blood test. This doesn’t by itself indicate MS, but people with MS may have a problem with zinc. However, the research on zinc in MS is contradictory. Some studies indicate that people with MS may have a deficiency in zinc, while others show that the levels of zinc may actually be high. The research does show that zinc to some extent has a negative effect on the immune system and has shown to worsen the symptoms of an animal study subject with MS. For this reason, supplementing with zinc may not be a good idea.
  • Copper-deficiency myelopathy. This is copper deficiency leading to spinal cord injury or damage. Doctors diagnose the condition based on a blood test that looks at the levels of copper and copper-carrying proteins in the blood. This condition can also mimic the symptoms of MS. One of the causes can be consuming high doses of zinc, such as in the form of zinc supplements.

After you receive a diagnosis, you may feel a sense of shock or dread. You may have an idea about what multiple sclerosis looks or feels like that you’ve gotten from pop culture. You may be experiencing symptoms, which may or may not align with that idea.

There’s no cure for MS, so it can be helpful to allow yourself time to adjust to this new reality and to the fact that it requires a lifetime commitment to managing this disease.

In addition to your primary doctor, you’ll also need to add a neurologist to your healthcare team to help evaluate symptoms and monitor your disease progression.

Though sometimes MS can lead to severe disability, most people continue to have a good quality of life and can expect a normal lifespan with the support of their healthcare team.

You may find it helpful to join an MS support group, either online or in-person, as a complement to your treatment plan.

Although everyone’s experiences with MS are different, it might help to share your experiences with others.

The next step is to talk with your doctor and begin developing a treatment plan. It may be helpful to do some research on MS so you can come to your doctor’s appointment having some information and being better prepared to ask questions about available treatments.

You may want to ask:

Am I a candidate for disease-modifying drugs?

The Food and Drug Administration has approved one medication, Ocrevus (ocrelizumab), for treating primary-progressive MS (PPMS).

Other disease-modifying drugs exist on the market to reduce relapses and slow disease progression in relapsing MS, but they haven’t been shown to work for progressive types of MS such as PPMS and relapsing forms of MS. Clinical research is underway to develop other medications to treat these forms of MS.

In addition, these powerful drugs must be taken consistently to be effective, and they can have serious side effects. Be sure to discuss the pros and cons of each with your doctor. Other symptoms, such as fatigue, can also be treated.

What’s the best way to manage my symptoms?

Ask your doctor what they recommend. This may involve a number of strategies but will likely involve medications. The type of medication will depend on the type of symptoms you have.

The National Multiple Sclerosis Society lists a variety of sample medications commonly proscribed to manage a variety of common symptoms of MS.

What happens if my symptoms worsen?

The disease process of MS often tends to go into remission and then relapse. This is known as relapsing-remitting MS. If this happens and the relapse is severe, your doctor may put you on a treatment of corticosteroids. You may have to take this orally or receive it intravenously.

When this doesn’t work, additional treatment options may include plasmapheresis or Acthar Gel. However, the former is expensive and not widely available. Your doctor will advise you what’s the best course of action for you.