So MS is diagnosed by a couple of different things. So it’s a combination of the person’s history, um, the symptoms that they report to their doctor, their physical exam, and also imaging such as MRI.
So a person has to have a typical history of symptoms that are like multiple sclerosis, which include let’s say numbness or tingling that lasted for several weeks and improved. Sometimes they’ll have vision loss that came on and lasted for a while and improved. And then in combination with that, we usually do MRIs of the brain and of the spinal cord, which show us lesions or white spots.
Those white spots that we see on MRI are the areas where the immune system has damaged the nerves. And so when that Milan is removed, it shows up white. And so that’s what your doctor is looking at or that’s what the doctor looks at when they look at those MRI scans.
So we have to have a combination of symptoms plus MRI abnormalities to diagnose MS. So a person that only has symptoms we don’t necessarily diagnose in that case. And in a person who only has MRI changes and doesn’t have symptoms, also doesn’t necessarily have MS.
There are some times other tests that we can do including a lumbar puncture or spinal tap and some blood tests that we have to do to rule out other diseases because there are vitamin deficiencies that can mimic MS. And also there are other rheumatologic conditions that can mimic MS. So we are not only looking at
things to confirm diagnosis, but we’re also making sure that they’re not other reasonable causes for those symptoms before we make a diagnosis of multiple sclerosis.
What are some of the challenges in forming a diagnosis?
Some of the challenges in diagnosing ms is that sometimes our memories are not as good as we think.
So one of the difficulties is that oftentimes when people come to the attention of a medical professional for a specific symptom, they may have had symptoms before that that can help us confirm the diagnosis. And so it’s very important, um, because sometimes people forget the symptoms that they may have had, especially if they were 10 or 15 years ago and they went away and didn’t recur.
So sometimes that can make the diagnosis difficult. Also sometimes we may catch the MRI changes before we actually see symptoms. And so for instance, I’ve had multiple people who have had let’s say a car accident and had an MRI for a car accident and their MRI looked like a mess, but they never had symptoms. So sometimes we have to wait and make sure that the symptoms are related to the lesions.
Also, people can have white spots in their brains for a variety of reasons. So they used to actually call them UBOs, unidentified bright objects, on MRI scans, but people can have white spots on their MRI if they have migraines. Um, if they have other diseases like high blood pressure and diabetes, they can develop those white spots. So we have to make sure that the white spots that we’re seeing are related to multiple sclerosis and not to something else. So that sometimes can make the diagnosis a bit difficult.
One other reason that diagnosis can be difficult is some people can’t receive MRIs if they have things like pacemakers or other devices that they’ve had and planted for other conditions. So sometimes we have to use multiple different ways to try to put the story together to make the diagnosis. And sometimes it takes a little bit of time and we have to keep doing those MRIs until we see that everything matches up.
Dr. Mitzi Joi Williams is a top neurologist and Multiple Sclerosis (MS) Specialist in Atlanta, Georgia. She received her undergraduate degree in Neuroscience and Behavioral Biology from Emory University and her Doctor of Medicine degree from Morehouse School of Medicine. Dr. Williams completed her internship and residency in neurology as well as a Clinical Fellowship in Multiple Sclerosis at the Medical College of Georgia in Augusta, GA. Dr. Williams has a strong interest in understanding and furthering research in MS in ethnic minority populations. She is a sought-after speaker and presenter and has discussed her research both nationally and internationally at various scientific meetings. She has spearheaded and participated in multiple Steering Committees and Work Groups to further research in underserved populations with MS. She also has recently increased involvement in efforts to increase diversity in clinical research and educate the community about the importance of research participation. Dr. Williams is the author of MS Made Simple: The Essential Guide to Understanding Your Multiple Sclerosis Diagnosis. Because of her passion for teaching and advocacy.
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