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How Is Multiple Sclerosis Diagnosed?

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article originally printed on page 19 in the July 17-18, 2004 issue
Reprinted on page 9 in the October 1011, 2009 issue of
The Mississauga News under the feature: Health, Wellness & Beauty, Medicine Matters.

To understand the diagnosis, you need to understand the disease itself. Multiple Sclerosis (MS) is a disease that affects the nervous system. Nerve cells are long slender structures that convey signals between our body and the spinal cord or brain. Nerve cells link our muscles, organs and sensory structures to the brain. For example, the ability to read this article relies on a bundle of optic nerves transmitting signals generated by light hitting the the retina at the back of the eyeball, and then being interpreted as recognizable writing in the brain. The long axons of these cells are surrounded by myelin, which is a type of insulating substance that allows for speedier and more accurate transmission. Current thinking suggests that inflammation is involved which damages this myelin resulting in plaques or scars in many places. The trigger may be genetic or environmental and remains elusive. These plaques alter the nerve signal conduction to produce symptoms. Our own immune system plays an as yet mysterious role in MS, and recently it has been suggested that MS is an autoimmune disorder in which our system is somehow tricked into producing myelin-destroying antibodies.

MS is more common than most people think. It affects 1 in a 1000 Canadians and first symptoms appear between the ages of 20 to 40. There is no "typical" presentation and symptoms can differ vastly between people, making the diagnosis difficult. Symptoms can include visual problems, hand or foot numbness, recurrent fatigue, pain, bladder and bowel problems, tremors and sexual problems. MS has two patterns of progression. The majority of MS sufferers fall into the relapsing category where symptoms tend to come and go over the years, and then at some point tend to worsen. A minority of patients tend to progress after the initial diagnosis, representing the most severe group. It is no wonder that MS patients are also prone to bouts of depression.

The diagnosis cannot be made by a one-time visit to a walk-in clinic or emergency department. It involves reporting of symptoms to your physician who will track and correlate the data over time. This is essential to rule out other causes such as tumors, diabetes, trauma, infections and other diseases. The diagnosis requires at least two relapses of a particular symptom. An MRI is not diagnostic, but is now considered a vital part of the diagnostic work-up. A blood test to detect anti-bodies may soon be available. The final diagnosis is best left to be made by a qualified neurologist.

Treatment is initially aimed at alleviating the symptoms. Steroids for inflammation, painkillers, anti-spasmodics, and sedatives all have a role to provide comfort and functioning during a relapse. Injectable Beta-Interferon is currently the first line treatment in a severe relapse. It is associated with significant side effects, and with time our immune system can produce neutralizing anti-bodies nullifying interferon action. Other injectables are on the market, but as yet have not lived up to expectations.

Related resources:

Multiple Sclerosis from Wikipedia, the free encyclopedia. "MS, also known as disseminated sclerosis or encephalomyelitis disseminata, is an idiopathic disease of suspected autoimmune cause, in which the body's immune response attacks a person's central nervous system (brain and spinal cord), leading to demyelination."

Multiple Sclerosis from MedicineNet.

All About Multiple Sclerosis from Mult-Sclerosis.org by Paul Jones.

Multiple Sclerosis Encyclopedia, Explaining Multiple Sclerosis and Famous People with Multiple Sclerosis from Mult-Sclerosis.org by Paul Jones.

Multiple Sclerosis Health Centerfrom WebMD.

Multiple Sclerosis from BUPA.

Multiple Sclerosis Facts from HealingWell.com.

Understanding MS - An educational resource for patients and families living with Multiple Sclerosis.

Multiple Sclerosis Guide: Overview & Facts from WebMD. What Is Multiple Sclerosis? What Causes Multiple Sclerosis (MS)?

Genetics of Multiple Sclerosis by Dyment DA, Ebers GC, and Sadovnick AD, Wellcome Trust Center for Human Genetics, University of Oxford, Oxford, UK.

Multiple Sclerosis from MedlinePlus.

Multiple Sclerosis News. News on Multiple Sclerosis continually updated from thousands of sources around the net, from Topix.com.

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