Multiple sclerosis (MS) is a chronic, progressive autoimmune condition that affects the central nervous system. MS occurs when the immune system attacks the myelin that protects the nerve fibers in the spinal cord and brain.

This is known as demyelination, and it causes communication difficulty between the nerves and the brain. Eventually it can result in damage to the nerves.

The cause of MS is currently unknown. It’s thought that genetic and environmental factors can play a role. There’s currently no cure for MS, though there are treatments that can reduce symptoms.

MS can be difficult to diagnose. There’s no single test that can diagnose it. Instead, a diagnosis typically requires multiple tests to rule out other conditions with similar symptoms.

After your doctor conducts a physical examination, they’ll likely order several different tests if they suspect you may have MS.

Blood tests will likely be part of the initial testing if your doctor suspects you might have MS. Blood tests can’t currently result in a firm diagnosis of MS, but they can rule out other conditions. These other conditions include:

All of these disorders can be diagnosed with bloodwork alone. Blood tests can also reveal abnormal results. This can lead toward diagnoses such as cancer or a vitamin B12 deficiency.

Magnetic resonance imaging (MRI) is the test of choice for diagnosing MS in combination with initial blood tests. MRIs use radio waves and magnetic fields to evaluate the relative water content in tissues of the body. They can detect normal and abnormal tissues and can spot irregularities.

MRIs offer detailed and sensitive images of the brain and spinal cord. They’re much less invasive than X-rays or CT scans, which both use radiation.

Purpose

Doctors will be looking for two things when they order MRI testing for possible MS:

  • any abnormalities that could rule out MS
  • evidence of demyelination

The layer of myelin that protects the nerve fibers is fatty and repels water when it’s undamaged. If the myelin has been damaged, however, this fat content is reduced or stripped away entirely and no longer repels water. The area will hold more water as a result, which can be detected by MRIs.

To diagnose MS, doctors must find evidence of demyelination. In addition to ruling out other potential conditions, an MRI can provide solid evidence that demyelination has occurred.

Preparation

Before you go in for your MRI, you should remove all jewelry. If you have any metal on your clothes (including zippers or bra hooks), you’ll be asked to change into a hospital gown.

You’ll lie still inside the MRI machine (which is open on both ends) for the duration of the procedure, which takes between 45 minutes and 1 hour. Let your doctor and technician know ahead of time if you have:

  • metallic implants
  • a pacemaker
  • tattoos
  • implanted drug infusions
  • artificial heart valves
  • a history of diabetes
  • any other conditions that you think could be relevant

Lumbar puncture, also called a spinal tap, is sometimes used in the process of diagnosing MS. This procedure will remove a sample of your cerebrospinal fluid (CSF) for testing.

During the procedure, a needle is inserted into your lower back, between vertebrae, and into the spinal canal. This hollow needle will collect the sample of CSF for testing.

A lumbar puncture typically takes about 30 minutes, and you’ll be given a local anesthetic. You’ll probably be asked to lie on one side with your spine curved.

After the area has been cleaned and a local anesthetic has been administered, a doctor will insert the hollow needle into the spinal canal to withdraw one to two tablespoons of CSF. Usually there’s no special preparation, though you may be asked to stop taking blood thinners.

Doctors who order lumbar punctures during the process of an MS diagnosis will use the test to rule out conditions with similar symptoms. They’ll also look for signs of MS, such as:

  • elevated levels of antibodies called IgG antibodies
  • proteins called oligoclonal bands
  • an unusually high number of white blood cells

People with MS may have a white blood cell count that’s up to seven times higher than normal. However, these abnormal immune responses can also be caused by other conditions.

It’s also estimated that 5 to 10 percent of people with MS don’t show any abnormalities in their CSF.

Evoked potential (EP) tests measure the electrical activity in the brain that occurs in response to stimulation, such as sound, touch, or sight. Each type of stimuli evokes minute electrical signals, which can be measured by the electrodes placed on the scalp to monitor activity in certain areas of the brain.

There are three types of EP tests. The visual evoked response (VER or VEP) is the one most commonly used to diagnose MS.

When doctors order an EP test, they’re going to look for impaired transmission along the optic nerve pathways. This typically happens early in most MS patients. However, before concluding that abnormal VERs are due to MS, other ocular or retinal disorders must be excluded.

No preparation is necessary to take an EP test. During the test, you’ll sit in front of a screen that has an alternating checkerboard pattern on it. You may be asked to cover one eye at a time. It does require active concentration, but it’s safe and noninvasive.

If you wear glasses, ask your doctor ahead of time whether you should bring them.

Medical knowledge is always advancing. As technology and our knowledge of MS moves forward, doctors may find new tests to make the MS diagnosis process a simpler one.

A blood test is currently being developed that will be able to detect biomarkers that are associated with MS. While this test likely won’t be able to diagnose MS on its own, it can help doctors evaluate risk factors and make diagnosis just a little easier.

Most people who receive an MS diagnosis are between the ages of 20 and 40. However, an MS diagnosis can come at any age, ranging from childhood to ages above 40.

Diagnosing MS currently can be challenging and time consuming. However, symptoms supported by MRIs or other test findings combined with the elimination of other possible causes can help make the diagnosis clearer.

If you’re experiencing symptoms that resemble MS, make an appointment with your doctor. The sooner you get diagnosed, the sooner you can get treatment, which can help to alleviate symptoms.

It can also be helpful to talk with others who are going through the same thing. If you’d like to share advice and stories in a supportive environment, considering joining our MS Buddy community. The MS Buddy app is free and available for iPhone or Android.