Table of ContentsView AllTable of ContentsGetting a DiagnosisMS Diagnostic CriteriaTests Used Besides MRIAge at DiagnosisRisks of Undiagnosed MSNext in Multiple Sclerosis GuideHow Multiple Sclerosis Is Treated
Table of ContentsView All
View All
Table of Contents
Getting a Diagnosis
MS Diagnostic Criteria
Tests Used Besides MRI
Age at Diagnosis
Risks of Undiagnosed MS
Next in Multiple Sclerosis Guide
The good news is that after extensive revisions of the McDonald criteria (a formal set of MS diagnostic guidelines) and the emergence of sophisticatedmagnetic resonance imaging(MRI) techniques, multiple sclerosis can now be diagnosed more timely and accurately.
This article reviews the steps of getting an MS diagnosis, from seeing a neurologist to undergoing various tests like an MRI of the brain. It also discusses the typical age for an MS diagnosis and the risks of going undiagnosed.
Verywell / Emily Roberts
How to Get MS Diagnosed
Aneurologistis a medical doctor specializing in brain, spinal cord, and nerve diseases, and they are responsible for diagnosing MS.
Neurologists perform a detailed medical history when evaluating someone for possible MS. They also ask about symptoms and collect data from various blood and imaging tests (and sometimes procedures) to determine if that person fulfills the McDonald criteria.
Information from this detailed evaluation also helps rule out alternative diagnoses.
Get a Neurologist Referral
If you are experiencing possible MS symptoms, seeing a neurologist is essential.
A primary care provider can often assist you with a neurology referral, or you can make the appointment on your own, depending on your insurance type.
The National MS Society—a prominent MS education and awareness organization—offers an easy-to-navigatetoolfor finding neurologists near you.
When choosing a neurologist, consider factors like traveling distance from your home or work, their approach to treatment (if diagnosed), and whether they are up-to-date on the latest MS research.
How to Find a Neurologist for Multiple Sclerosis
Medical History
MS is a complex disease, so thoroughly investigating a person’s medical history is essential.
During such an evaluation, a neurologist will inquire about the following:
What Causes Multiple Sclerosis?
Record and Track Symptoms
The symptoms of MS are highly variable, often intermittent, and can be nonspecific, meaning similar to those found in other conditions. As such, before or between appointments with a neurologist, try writing down how you feel, whether in a notebook or on your phone or computer.
Recording symptoms can help you and your neurologist track potential patterns and triggers and, in the future, if diagnosed, determine whether MS treatments are working.
Common symptoms of MS include:
Differential Diagnosis for MSAlthough not an exhaustive list,health conditions that resemble MSinclude:Neuromyelitis opticaandacute disseminated encephalomyelitis(both neurological diseases)Vitamin B12 deficiencyInfectious diseases likeLyme diseaseandhuman immunodeficiency virus (HIV)Other autoimmune diseases, namelylupus,Sjögren’s disease, andsarcoidosisStructural problems in the spine, such as aherniated disk
Differential Diagnosis for MS
Although not an exhaustive list,health conditions that resemble MSinclude:Neuromyelitis opticaandacute disseminated encephalomyelitis(both neurological diseases)Vitamin B12 deficiencyInfectious diseases likeLyme diseaseandhuman immunodeficiency virus (HIV)Other autoimmune diseases, namelylupus,Sjögren’s disease, andsarcoidosisStructural problems in the spine, such as aherniated disk
Although not an exhaustive list,health conditions that resemble MSinclude:
The McDonald criteria are guidelines neurologists use to diagnose MS. With multiple revisions over the years, these guidelines have improved the accuracy and promptness of MS diagnosis.
According to the criteria, the essential step to diagnosing MS is uncovering evidence of damage in at least two parts of thecentral nervous system(consisting of the brain, spinal cord, and the eyes’optic nerves) occurring at different points over time.
Evidence for this premise, calleddissemination in space and time, is primarily obtained from a person’s medical history,neurological exam, and MRI of the brain and sometimes spinal cord.
What Is an MRI?An MRI is a noninvasive imaging technology that produces three-dimensional (3D) images of the body’s soft tissues using magnetic fields and radio waves. It’s the most sensitive test for detecting MS-related damage in the central nervous system.
What Is an MRI?
An MRI is a noninvasive imaging technology that produces three-dimensional (3D) images of the body’s soft tissues using magnetic fields and radio waves. It’s the most sensitive test for detecting MS-related damage in the central nervous system.
On the MRI, neurologists look forlesions(areas of damage or scarring), signifying that a person’simmune systemhas malfunctioned and attacked the fatty (myelin) sheath surrounding nerve cells.
The damage—known asdemyelination—is what causes the varyingsymptoms of MS(e.g., blurry vision, numbness, and muscle weakness, among many others).
MS lesions do not always cause symptoms. This is why, according to the revised 2017 McDonald criteria, the presence of any lesions, whether a person has symptoms or not, supports the principle of dissemination in space or time.
Also, in the revised criteria, under some circumstances,oligoclonalbands in a person’scerebrospinal fluid(CSF) can be used instead of dissemination in time to establish an MS diagnosis.
An example of this scenario would be if someone has MRI lesions in two or more brain regions but has only experienced one MSrelapse(episode of new or worsening neurological symptoms).
What Are Oligoclonal Bands?Oligoclonal bands areantibodies(proteins) released into the CSF during an MS attack. They indicate inflammation within the central nervous system and are present in more than 95% of people with MS.
What Are Oligoclonal Bands?
Oligoclonal bands areantibodies(proteins) released into the CSF during an MS attack. They indicate inflammation within the central nervous system and are present in more than 95% of people with MS.
Besides an MRI, other tests may help establish an MS diagnosis or rule out mimicking conditions.
Lumbar Puncture
As mentioned above, specific inflammatory proteins within a CSF sample may be used to confirm an MS diagnosis in some settings. The CSF is the fluid that bathes and protects your brain and spinal cord.
A CSF sample is obtained through alumbar puncture(called a spinal tap), generally performed in the neurologist’s office.
During the procedure, a person will lay on their side or sit on the edge of a bed, bent forward. The neurologist will then clean the lower back and inject a numbing medicine.
A needle will then be inserted between the vertebrae of their lower back to reach thespinal column, where a small amount of CSF will be removed using a syringe and eventually analyzed in a laboratory.
Evoked Potentials
Evoked potential tests measure how fast nerve signals reach the brain and how large or small a nerve response is when stimulated.
These tests are sensitive in detecting MS lesions because nerve signaling is slowed and less efficient when myelin is damaged.
Two types of evoked potentials sometimes used to help detect MS are:
Blood Tests
Blood tests can help assess a person’s health and rule out differential diagnoses.
Examples of such tests include:
The Role of Blood Tests in Diagnosis MS
Typical Age of MS Diagnosis
Although MS can develop at any age, it’s generally detected in young adulthood, between the ages of 20 and 40. Around 5% of cases are diagnosed at 50 or older (calledlate-onset MS),and 3% to 10% of MS cases occur before the age of 16.
Interestingly, forrelapsing-remitting MS(RRMS), the median age of onset is 30 years. Forprimary progressive MS(PPMS), the median age of onset is 40 years.
RRMS Vs. PPMS
Types of Multiple Sclerosis Overview
Unfortunately, due to the variable, subtle, and often intermittent symptoms of MS, a person may go undiagnosed for years. The risk of delaying an MS diagnosis is that it prevents the early initiation of a disease-modifying treatment (DMT).
Early Initiation of MS DMT
Moreover, in addition to a delayed diagnosis, an MS misdiagnosis is also relatively common. In one study, nearly 1 in 5 people were diagnosed with MS when they did not fulfill the current McDonald criteria. In such cases, alternative diagnoses were more likely.
Misdiagnosing someone with MS creates stress and carries a high physical and emotional burden. A person may take MS-related medications that bring on side effects and alter their lifestyle unnecessarily based on the diagnosis.
A misdiagnosis also means that the actual condition remains untreated, which can contribute to a worsening of the disease.
Diseases That Can Mimic Multiple Sclerosis
Summary
The diagnosis of MS is complex because there is no single test to confirm a person has the disease. Instead, neurologists use a formal set of guidelines called the McDonald Criteria to make the diagnosis.
The key principle of the McDonald criteria is that it provides evidence of damage to the central nervous system (CNS) at different times and to different parts—referred to as “dissemination in time and space.”
To determine if a person fulfills the McDonald criteria, neurologists gather data from a person’s medical history, neurological examination and magnetic resonance imaging (MRI) imaging of their brain and sometimes spinal cord.
Results from other tests, like a spinal tap and blood tests, are also used to establish MS and rule out differential diagnoses.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-XGhasemi N, Razavi S, Nikzad E.Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy.Cell J. 2017;19(1):1-10. doi:10.22074/cellj.2016.4867 (doi does not work)Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Ömerhoca S, Akkaş SY, İçen NK.Multiple sclerosis: diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1-S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.Thompson AJ, Banwell BL, Barkhof F, et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2Graner M, Pointon T, Manton S, et al.Oligoclonal IgG antibodies in multiple sclerosis target patient-specific peptides.PLoS One. 2020;15(2):e0228883. doi:10.1371/journal.pone.0228883Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319 doi:10.1177/1352458517707265Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M.Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis.Mult Scler Relat Disord. 2021;50:102816. doi:10.1016/j.msard.2021.102816Alroughani R, Boyko A.Pediatric multiple sclerosis: a review.BMC Neurol. 2018;18(1):27. doi:10.1186/s12883-018-1026-3McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: a review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Kaisey M, Solomon AJ, Luu M, Giesser BS, Sicotte NL.Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers.Mult Scler Relat Disord. 2019;30:51-56. doi:10.1016/j.msard.2019.01.048
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-XGhasemi N, Razavi S, Nikzad E.Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy.Cell J. 2017;19(1):1-10. doi:10.22074/cellj.2016.4867 (doi does not work)Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Ömerhoca S, Akkaş SY, İçen NK.Multiple sclerosis: diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1-S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.Thompson AJ, Banwell BL, Barkhof F, et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2Graner M, Pointon T, Manton S, et al.Oligoclonal IgG antibodies in multiple sclerosis target patient-specific peptides.PLoS One. 2020;15(2):e0228883. doi:10.1371/journal.pone.0228883Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319 doi:10.1177/1352458517707265Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M.Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis.Mult Scler Relat Disord. 2021;50:102816. doi:10.1016/j.msard.2021.102816Alroughani R, Boyko A.Pediatric multiple sclerosis: a review.BMC Neurol. 2018;18(1):27. doi:10.1186/s12883-018-1026-3McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: a review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Kaisey M, Solomon AJ, Luu M, Giesser BS, Sicotte NL.Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers.Mult Scler Relat Disord. 2019;30:51-56. doi:10.1016/j.msard.2019.01.048
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-XGhasemi N, Razavi S, Nikzad E.Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy.Cell J. 2017;19(1):1-10. doi:10.22074/cellj.2016.4867 (doi does not work)Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131Ömerhoca S, Akkaş SY, İçen NK.Multiple sclerosis: diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1-S9. doi:10.29399/npa.23418Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.Thompson AJ, Banwell BL, Barkhof F, et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2Graner M, Pointon T, Manton S, et al.Oligoclonal IgG antibodies in multiple sclerosis target patient-specific peptides.PLoS One. 2020;15(2):e0228883. doi:10.1371/journal.pone.0228883Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319 doi:10.1177/1352458517707265Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M.Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis.Mult Scler Relat Disord. 2021;50:102816. doi:10.1016/j.msard.2021.102816Alroughani R, Boyko A.Pediatric multiple sclerosis: a review.BMC Neurol. 2018;18(1):27. doi:10.1186/s12883-018-1026-3McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: a review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858Kaisey M, Solomon AJ, Luu M, Giesser BS, Sicotte NL.Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers.Mult Scler Relat Disord. 2019;30:51-56. doi:10.1016/j.msard.2019.01.048
Brownlee WJ, Hardy TA, Fazekas F, Miller DH.Diagnosis of multiple sclerosis: progress and challenges.Lancet. 2017;389(10076):1336-1346. doi:10.1016/S0140-6736(16)30959-X
Ghasemi N, Razavi S, Nikzad E.Multiple sclerosis: pathogenesis, symptoms, diagnoses and cell-based therapy.Cell J. 2017;19(1):1-10. doi:10.22074/cellj.2016.4867 (doi does not work)
Kale N.Optic neuritis as an early sign of multiple sclerosis.Eye Brain.2016;8:195–202. doi:10.2147/EB.S54131
Ömerhoca S, Akkaş SY, İçen NK.Multiple sclerosis: diagnosis and differential diagnosis.Noro Psikiyatr Ars. 2018;55(Suppl 1):S1-S9. doi:10.29399/npa.23418
Farshidfar Z, Faeghi F, Haghighatkhah HR, Abdolmohammadi J.The optimization of magnetic resonance imaging pulse sequences in order to better detection of multiple sclerosis plaques.J Biomed Phys Eng.2017;7(3):265–270.
Thompson AJ, Banwell BL, Barkhof F, et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018;17(2):162-173. doi:10.1016/S1474-4422(17)30470-2
Graner M, Pointon T, Manton S, et al.Oligoclonal IgG antibodies in multiple sclerosis target patient-specific peptides.PLoS One. 2020;15(2):e0228883. doi:10.1371/journal.pone.0228883
Hardmeier M, Leocani L, Fuhr P.A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS.Mult Scler. 2017;23(10):1309-1319 doi:10.1177/1352458517707265
Naseri A, Nasiri E, Sahraian MA, Daneshvar S, Talebi M.Clinical features of late-onset multiple sclerosis: a systematic review and meta-analysis.Mult Scler Relat Disord. 2021;50:102816. doi:10.1016/j.msard.2021.102816
Alroughani R, Boyko A.Pediatric multiple sclerosis: a review.BMC Neurol. 2018;18(1):27. doi:10.1186/s12883-018-1026-3
McKay KA, Kwan V, Duggan T, Tremlett H.Risk factors associated with the onset of relapsing-remitting and primary progressive multiple sclerosis: a systematic review.Biomed Res Int. 2015;2015:817238. doi:10.1155/2015/817238
McGinley MP, Goldschmidt CH, Rae-Grant AD.Diagnosis and treatment of multiple sclerosis: a review.JAMA.2021;325(8):765-779. doi:10.1001/jama.2020.26858
Kaisey M, Solomon AJ, Luu M, Giesser BS, Sicotte NL.Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers.Mult Scler Relat Disord. 2019;30:51-56. doi:10.1016/j.msard.2019.01.048
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
