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Multiple sclerosis is an autoimmune condition characterized by repeated episodes of inflammation over time to different parts of the brain and spinal cord. There is no one test to diagnose MS, rather clinicians use multiple methods to arrive at the final diagnosis and that process can differ among patients. The patient’s history and physical examination are still the most important tools for the diagnosis. However, as technology has advanced, MRI’s of the brain and spinal cord have become indispensable and every patient with whom MS is being considered should have a MRI. MRI’s may reveal areas of inflammation, which we refer to as lesions or scars. However there are a number of conditions that can cause these scars, which may actually appear very similar to MS on a MRI. Subtle differences in the shape, location or size of lesions may help differentiate MS from these other conditions. At the time of diagnosis, relatively extensive bloodwork is also necessary to rule out some of these other conditions that can cause inflammation, however, there is no available blood test specific for the diagnosis of MS.
A lumbar puncture or spinal tap is a procedure in which a small amount of the cerebrospinal fluid (CSF), which bathes the brain and spinal cord, is removed for analysis. The test used to aid in the diagnosis of MS is primarily ‘oligoclonal bands’ (abnormal immunoglobulin production by immune cells in the CSF). However, as this is only present in approximately 85% of MS patients, it is not definitive by itself and is often not necessary for a standard new patient diagnosis. Often the CSF is only examined when the clinician is concerned that an alternate inflammatory process or infection is the cause.
‘Evoked potentials’ measure the speed of electrical conduction for vision, hearing and sensation. These can be delayed in patients with MS but also in a variety of other conditions. Although they are helpful in some cases, evoked potentials are rarely used in the diagnosis of MS today.
At the IMSMP, our neurologists have a combined total of over 60 years diagnosing multiple sclerosis. What's more, the close proximity to the Tisch MS Research Center of New York allows our MS specialists to take a blood or csf samples and walk it steps down the hall to our state-of-the-art research facility. This unique affiliation aids in confirming a diagnosis of MS and can even help detect what treatment may be best suited for that patient by reviewing with the scientist how that patient's cells are reacting. That is not being done anywhere else.