Multiple sclerosis

Multiple sclerosis (MS) is a non-contagious chronic disease of the brain and spinal cord characterized by a variety of neurologic symptoms caused by demyelination of neurons. Multiple sclerosis results from attack by a patient's own immune system on their central nervous system and is thus categorized as an autoimmune disease.

Diagnosis

Multiple sclerosis can be difficult to diagnose in its early stages - in fact, definite diagnosis of MS cannot be made until there is evidence of at least two anatomically separate demyelinating events occurring at least thirty days apart. The McDonald criteria represent international efforts to standardize the diagnosis of MS using clinical data, laboratory data, and radiologic data. {{an|McDonald}}

Related Topics:
Anatomically - McDonald criteria

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• Clinical data alone is sometimes enough to satisfy the diagnosis; if a patient has suffered two separate sets of neurologic symptoms characteristic of MS with supporting abnormalities on physical examination, a diagnosis of MS can be made with no further testing. Since many patients come to medical attention after suffering their initial attack, other testing has been studied to help hasten the diagnosis and initiation of therapy.
• Magnetic resonance imaging (MRI) reveals areas of demyelination as bright lesions on T2 images or when gadolinium contrast is used. MRI can show lesions which occurred prior to a recent attack but produced no clinical symptoms. MRI can thus reveal evidence of the chronicity needed for definite diagnosis.
• Lumbar puncture, a procedure done to collect a sample of cerebrospinal fluid (CSF), can provide evidence of chronic inflammation of the central nervous system. Oligoclonal bands are immunoglobulins which can be isolated from the CSF and are present in 85 to 95% of patients with definite MS but which can be found in other diseases as well. {{an|Rudick}} Combined with MRI and clinical data, oligoclonal bands can be used to help make a definite diagnosis of MS.
• Visual evoked potentials (VEPs) and somatosensory evoked potentials (SEPs) test the brain's response to stimulation of the optic nerve and sensory nerves respectively. Decreased activity on either test can reveal involvement by MS which is otherwise asymptomatic. Along with the other pieces of data, these exams can help establish disseminated involvement required for definite diagnosis. {{an|Gronseth}}

An additional test which may become important in the future involves measurement of antibodies directed against myelin proteins such as myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP). At this time, however, there is no established role for these tests in the diagnosis of MS.

Related Topics:
Antibodies - Protein - Myelin oligodendrocyte glycoprotein - Myelin basic protein

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The signs and symptoms of MS can be similar to other diseases such as stroke, Acute disseminated encephalomyelitis, infections, tumors, and lupus. Additional testing may be employed to help differentiate MS from these other diseases if necessary.

Related Topics:
Stroke - Acute disseminated encephalomyelitis - Infection - Tumor - Lupus

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