Multiple Sclerosis

MS can be hard to diagnose because it affects everyone differently. Blurry vision, “pins and needles” tingling, dizziness and fatigue (feeling really tired) are just a few of the things you could experience. And even these symptoms can vary over time.

There can also be difference depending on what type of MS you have. The three specific types of MS are:

• Relapsing-remitting MS (RRMS): This is by far the most common type of MS. With this type, you’ll have distinct relapses (also called attacks, flares or exacerbations) of new symptoms that continue to build, followed by complete or partial recovery (called remission).
• Primary progressive MS (PPMS): With primary progressive MS, you typically won’t have relapses, or you’ll have very few.  Instead, your primary (first) symptoms will gradually progress.
• Secondary progressive MS (SPMS): This type of MS starts out as relapsing-remitting MS, but then typically progresses without any relapses.

A neurologist who specializes in MS will ask for a detailed medical history and talk with you about your symptoms. These MS experts use their expertise and understanding of the latest testing tools and techniques to provide a highly specific and individualized diagnosis.

Multiple sclerosis testing at Cleveland Clinic

Diagnosing MS can be like trying to solve a complicated puzzle. There are many pieces that you need to put together before the bigger picture is revealed. This isn’t something we do alone. We talk to you about your experiences, listen to what you’ve been feeling and work together to figure out what’s going on.

There isn’t one single symptom or test that confirms an MS diagnosis. And there are many conditions that have similar symptoms, so it’s important to rule out those conditions when diagnosing MS. To do that, we typically do the following tests:

• MRI: An MRI uses powerful magnets and radio waves to take detailed pictures of your brain and spinal cord.
• Lumbar Puncture (spinal tap): In this procedure, a small sample of spinal fluid (fluid that surrounds your brain and spinal cord) is removed from your lower back. This test helps to find abnormal proteins or inflammation typical of MS in your central nervous system.
• Optical Coherence Tomography (OCT): OCT is a test that scans the nerves in the back of your eye (retina) with a laser. It checks for myelin damage and will show if your condition is progressing. We can also use this test to see how your body is responding to treatment.
• Blood Tests: While there’s no definitive blood test for MS, we can look for other conditions that might be causing your symptoms.
• Evoked Potentials Study: This test uses electrodes (small patches with wires) attached to your head to measure how long it takes your brain to react when stimulated with sight, sound or touch. People with MS typically have longer reaction times.

We’ll use your medical history, neurological exam and often one or more of the tests mentioned above to help make an MS diagnosis. However, a firm diagnosis of MS can only happen when:

• Lesions (areas of damage) are found in at least two separate areas of your central nervous system — brain, spinal cord and optic (eye) nerves.
• The lesions happened at different times.
• All other possible diagnoses have been ruled out.

It’s important to note that your MS diagnosis may happen quickly or take a while depending on your situation. Its many different symptoms — which can easily look like other conditions — can make MS hard to pinpoint. Just as the condition is often unpredictable and challenging, so is the process of diagnosing it.

Even though MS is a chronic (lifelong) condition, we can help you manage the symptoms, reduce relapses, cope with emotional challenges and often slow the condition’s progression. Your personalized treatment may include:

• Disease-modifying therapies: There are more than 20 FDA-approved medications available as a pill, shot or an infusion (medicine that goes directly into your vein through an IV). These medications can help reduce how often relapses happen, while also helping to prevent damage to your central nervous system. They’re most helpful for people with relapsing-remitting MS, but can be used in progressive MS.
• Relapse management medications: Steroids, like oral prednisone or intravenous (through the vein) methylprednisolone (Solu-Medrol®), can help reduce inflammation.
• Physical therapy: A physical therapist can help with walking, strength and balance. They can also help you learn how to use a cane, scooter or wheelchair if you need one.
• Occupational therapy: An occupational therapist can teach you new, easier ways to do things around the house, at work or school. They’ll talk to you about products that can help make you feel better — like a cooling vest if you’re sensitive to heat.
• Speech therapy: A speech-language pathologist can help with changes in voice, speech and swallowing caused by MS.
• Cognitive therapy: A neuropsychologist can help with cognitive issues, such as attention, language and memory problems. A psychologist and psychiatrist can help with depression, anxiety, mood swings and feeling overwhelmed.
• Lifestyle changes: Eating a healthy balanced diet, getting regular exercise, managing stress, not smoking and limiting alcohol can sometimes help lessen your MS symptoms and lead to a greater sense of well-being overall.

Taking the Next Step

Living with MS is a different journey for everyone. That’s why it’s important to partner with specialists who have experience diagnosing and treating this often challenging condition. At Cleveland Clinic, our industry leading MS specialists are here to shed light on what’s going on and help you find the answers and treatment that’s just right for you.