Multiple Sclerosis

At a Glance

MS is considered in the presence of clinically objective neurologic deficits and evidence of past events of neurologic symptoms (e.g., in the patient history). The neurologic symptoms themselves are notoriously variable and can come in virtually any form. Typical symptoms include paresthesia, weakness, ataxia, dysarthria, sensory deficits, and impaired or double vision. Fatigue and psychiatric symptoms, such as depression or euphoria, can also be manifestations of MS. Symptoms (attacks) of MS need disseminated in “time and space.”

As the diagnosis of MS hinges on the identification of attacks of the disease, it is important to clearly define these. An MS attack is an episode with new or reactivated neurologic symptoms that:

  • lasts at least more than 24 hours
  • are separated by more than 30 days
  • are not triggered by changes in body temperature (Uhthoff phenomenon)

What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?

There is no specific test for MS. The diagnosis of MS rests on the history and neurologic examination, supplemented with laboratory tests and MRI. The laboratory work-up of MS is important to exclude chronic infectious diseases (e.g., HIV and Borreliosis), collagenoses, vasculitis, and leukodystrophies. The work-up includes CRP, complete blood count (CBC), blood serum, blood glucose, rheumatoid factor, vitamin B12, anti-phospholoipid antibodies, lupus anticoagulant testing, and ANA (anti-nuclear antibodies). All of these results would be expected to be normal in MS.

What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?

CSF analysis can strongly support the diagnosis of MS. CSF analysis consists of cytology and measurement of albumin, IgG-, IgA, and IgM-levels. In MS, CSF-electrophoresis will often reveal oligoclonal bands not detected in the serum and, hence, are evidence of intrathecal IgG production. CSF IgG is increased as a percentage of CSF protein or CSF albumin. Elevated myelin basic protein (MBP) in the CSF is indicative of active demyelination. CSF lymphocyte count and CSF protein are usually only slightly elevated, if at all.

Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?

Immunosuppressant drugs can mask some CSF markers of MS. But overall, since there are no specific laboratory markers of MS, there is little concern for interferences.