Identifying the early signs of MS
People with multiple sclerosis (MS) may present with a wide range of symptoms affecting different parts of the body. The most common are:
- loss or reduction of vision in 1 eye with painful eye movements
- double vision
- ascending sensory disturbance and/or weakness
- altered sensation or pain travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte’s sign)
- progressive difficulties with balance and gait.
Be aware that usually people with MS present with neurological symptoms or signs as described in recommendation, and:
- are often aged under 50 and
- may have a history of previous neurological symptoms and
- have symptoms that have evolved over more than 24 hours and
- have symptoms that may persist over several days or weeks and then improve and
- do not have fever or infection.
Do not routinely suspect MS if a person’s main symptoms are fatigue, depression, dizziness or vague sensory phenomena, unless they have a history or evidence of focal neurological symptoms or signs.
Initial assessment
Before referring a person suspected of having MS to a neurologist, confirm that this is a neurological episode by taking a history, undertaking a physical examination and excluding alternative, more common diagnoses.
Medical History & Neurological Examination:Medical History & Neurological Examination
The doctor collects a detailed history of symptoms, family background, and other relevant factors. A neurological exam assesses mental, emotional, and language functions, movement, coordination, balance, vision, and other senses. Keeping a record of symptoms and sharing them with your GP and neurologist is recommended for a comprehensive assessment
MRI (Magnetic Resonance Imaging)
MRI scans are the most effective imaging tool for detecting MS plaques or lesions in the brain and spinal cord. They help identify both old and new areas of damage, but a diagnosis cannot be made based on MRI alone, as similar lesions can occur in other conditions or even in healthy individuals
Evoked Potentials
These tests measure the nervous system’s electrical response to sensory stimulation (such as visual or auditory). They can reveal areas of slowed nerve conduction caused by demyelination, even when not detected in a standard exam
Lumbar Puncture (Spinal Tap)
Analysis of cerebrospinal fluid can detect immune proteins and oligoclonal bands, which indicate inflammation in the central nervous system.
These findings support an MS diagnosis but are not exclusive to MS
Blood Tests
While there’s no blood test for MS itself, blood tests are used to exclude other conditions that can mimic MS symptoms, such as infections or autoimmune diseases
Diagnostic Criteria
The internationally recognised McDonald Criteria (most recently revised in 2017) guide the diagnosis of MS.
To confirm MS, a doctor must find evidence of inflammatory damage in at least two separate areas of the central nervous system (CNS), occurring at different times, and rule out other possible diagnoses. The criteria allow for earlier diagnosis, even after a single clinical attack (Clinically Isolated Syndrome, or CIS), if MRI or other tests show additional evidence of disease.
Types of MS
MS can present in several forms, each with distinct patterns of symptoms and progression:
Clinically Isolated Syndrome
A first episode of neurological symptoms caused by inflammation or demyelination in the CNS, lasting at least 24 hours. CIS may or may not progress to MS, depending on MRI findings.
Relapsing Remitting MS
The most common type, marked by clearly defined relapses (attacks) followed by periods of full or partial recovery (remission). About 85% of people with MS are initially diagnosed with RRMS.
Secondary Progressive MS
Initially begins as RRMS, but over time, the disease transitions to a progressive course with or without occasional relapses, minor remissions, or plateaus.
Primary Progressive MS
Characterised by steadily worsening neurological function from the onset, without early relapses or remissions. About 10–15% of people with MS have PPMS.
Progressive Relapsing MS
A rare form featuring steady progression from the start, with occasional acute relapses.