Diagnosis

• MS is not easy to diagnose as it can cause a number of different symptoms
• its hard to pin point when MS begins
• the early signs and symptoms are different for everyone
• diagnosis can take several months
• a number of different causes need to be explored and many different tests need to be carried out
• The tests for MS
  • Neurological examination
    • Your neurologist will ask you lots of questions about past symptoms and problems – this is known as ‘history taking’. It helps the neurologist get a better picture of you and can help identify any other problems that may explain current symptoms.
    • A physical examination checks for changes or weaknesses in your eye movements, leg or hand coordination, balance, sensation, speech or reflexes. Whilst a neurologist may strongly suspect MS at this stage, a diagnosis won’t be given until other test results confirm MS.
  • Magnetic resonance imaging (MRI)
    • Confirm a diagnosis in over 90% of people with MS
    • An MRI scanner uses a strong magnetic field to create a detailed image of your brain and spinal cord. It is very accurate and can pinpoint the exact location and size of any damage or scarring (lesions).
    • To get the image of a person’s brain and spinal cord they must lie down and enter a small tunnel in the centre of the MRI scanner. The process can take between 10 and 60 minutes and is painless, though some people can feel a little claustrophobic in the scanner. The Newcastle Upon Tyne Hospitals NHS Foundation Trust has produced a video which explains what to expect when you have an MRI
  • Evoked Potentials
    • This involves testing the time it takes for your brain to receive messages
    • This is carried out by placing small electrodes on your head to monitor your brainwaves responding to what you see or hear.
    • If myelin damage has occurred, messages to and from your brain will be slower.
  • Lumbar Puncture
    • This is sometimes called a spinal tap.
    • It involves a needle being inserted into the space around your spinal cord, under local anaesthetic.
    • A small sample of the fluid that flows around the brain and spinal cord, called cerebrospinal fluid, is then taken and tested for abnormalities.
    • People with MS often have antibodies in this fluid.
    • People commonly report headaches following a lumbar puncture. The medical staff should advise you on how to manage this. Newer, smaller needles cause less discomfort, although they’re not yet being widely used.

Types of MS

• Relapsing remitting MS (RRMS)
  • 85% of people with MS are diagnosed with this type
  • distinct attacks of symptoms which then fade away either partially or completely
• Secondary progressive MS (SPMS)
  • sustained build up of disability. Completely independent of any relapses
  • Many people with RRMS go on to have SPMS
• Primary progressive MS (PPMS)
  • Affects 10-15% of people diagnosed with MS
  • Symptoms gradually get worse over time, rather than appearing as sudden attacks (relapses)

MS in children

• MS in children is rare. Around five to ten per cent of young people with MS will experience MS symptoms before the age of 16.

Benign MS

• If you have a small number of relapses followed by a complete recovery, you may be described as having benign MS.
• Benign MS can only be diagnosed retrospectively, after a period of at least 10 to 15 years.

Signs and Symptoms

• Early signs
  • Optic neuritis
    • one of the more obvious early symptoms, but this is often because this is a more ‘concrete’ symptom as opposed to ‘vague’ neurological symptoms like numbness or tingling.
• Balance
  • affect people differently
  • vary from day to day
• Bladder
  • two main types – storage and emptying
  • Doctors don’t know why some people get one or the other and other people get a bit of both
• Bowel
  • bowel incontinence
  • constipation
  • the two can be linked but not always
• Eyes and sight
  • Optic neuritis
    • inflation of the optic nerve
    • varies from blurred vision to complete loss of sight
    • this is the nerve that carries messages from the eye to the brain
  • Eye movement
    • the nerve pathways that control the movement of their eyes can be affected
    • eyes may not move smoothly
    • the two eyes may be out of alignment
• Fatigue
  • an overwhelming sense of tiredness that occurs after very little activity
  • affects people in different ways
  • may change daily or hourly
• Memory and thinking
  • cognitive problems
    • most people will be affected mildly
    • difficulty concentrating
    • being unable to find the right word
    • short term memory problems
• Mental health
  • depression
  • stress
  • anxiety
• Pain
  • invisible symptom
  • pain might feel like squeezing, crushing, cold, hot, stabbing or burning
  • MS hug – a tightness in the chest
• Sexual problems
  • around 50-80% of women will experience some form of sexual dysfunction
  • Men may have problems with erections and ejaculation
• Spasms and stiffness
  • common symptom
  • affect at least 20% of people with MS
  • affect people differently and vary over time
• Speech
  • 40-50% are affected by speech difficulties
  • MS damage in different parts of the brain affects the way speech is produced. This can cause problems that may come and go including slurred speech, low volume or a weak voice.
• Swallowing
  • damage to any part of the brain that controls swallowing
  • damage between the brain and the spinal cord
  • Temporary changes in swallowing can happen during a relapse and improve, or disappear completely, over time.
  • can become more difficult in the long term
• Tremor
  • trembling or shaking movement
  • cannot control voluntarily
  • for some people the tremor is so mild that they’re the only one aware of it
  • two kinds of tremor
    • intention tremor
      • comes when you want to reach for something
    • postural tremor
      • when you have a tremor as you sit or stand
  • MS tremors are usually caused by damage to myelin in an area of the brain known as the ‘cerebellum’, and the nerves leading to and from it.
  • For a small percentage of people, it is more severe, causing limbs to shake so that you need help with everyday tasks like eating and drinking.
  • Specialists like physiotherapists and occupational therapists can assess the problems that tremor and other movement difficulties are causing you.
• Pseudobulbar Affect
  • a neurologic effect that occurs in 10 percent of people with MS, although some research suggests a much larger percentage. It is characterized by sudden, uncontrollable expressions of laughter or crying without an apparent trigger.