Table of ContentsView AllTable of ContentsTypes and SymptomsTimely DiagnosisTestingThe McDonald CriteriaDiagnosis TimelinesAfter the DiagnosisFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Types and Symptoms
Timely Diagnosis
Testing
The McDonald Criteria
Diagnosis Timelines
After the Diagnosis
Frequently Asked Questions
Diagnosingmultiple sclerosis(MS) can be challenging. A combination of symptoms, lab tests, and exams need to be measured against a specific set of criteria known as the McDonald criteria for doctors toreach a diagnosis.
Since many symptoms of MS can develop from other health conditions,diagnostic toolsare also used to rule out other disorders while diagnosing MS. Diagnosing MS as early as possible is crucial to ensuring that a person with the disease has the best quality of life for as long as possible.
Types of MS and Symptoms
Thecentral nervous system, which includes the brain and spinal cord, is made up of cells and nerves that deliver messages to and from the brain. MS develops when the immune system begins attacking the myelin sheath, the covering of nerve fibers. Multiple sclerosis is anautoimmune disease.
When myelin becomes damaged, it can formlesions, or scar tissue, that prevent the brain and body from communicating properly. In some cases, nerves can become permanently damaged.
There are four main types of MS, all of which have different symptoms and progression timelines. In some cases, a person can develop one type of MS and it will progress to another over time.
Clinically Isolated Syndrome (CIS)
CIS refers to a first episode of neurological symptoms that lasts at least 24 hours. Symptoms may include:
Relapsing-Remitting Multiple Sclerosis (RRMS)
As many as 85% of people with MS are diagnosed at this stage.The symptoms of RRMS are the same as those in CIS, but they come on more frequently. Other symptoms that can happen with RRMS includefatigue, sensitivity to heat, and depression.
Primary Progressive Multiple Sclerosis (PPMS)
PPMScontinues to worsen over time. There are no symptom flare-ups and no remissions. How fast the disease progresses may vary. There can be times when the condition is stable, and there can be periods of short-term minor improvements.About 10%–15% of people with MS have this type.
People with PPMS have the same symptoms as those with CIS and RRMS. However, they can also have additional symptoms, such as:
Secondary Progressive Multiple Sclerosis (SPMS)
If the relapsing-remitting MS progresses to a point at which there are no discernible relapses and remissions, it has transitioned tosecondary progressive MS. In this type, symptoms accumulate and worsen without any remission.
There may be periods in which symptoms are stable. Often an individual will describe a change in their abilities when comparing current to past function but cannot identify an episode that led to the worsening.
RecapThere are four main types of MS: clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), primary progressive multiple sclerosis (PPMS), and secondary progressive multiple sclerosis (SPMS). Relapsing-remitting MS is the most common type, affecting 85% of people with multiple sclerosis.
Recap
There are four main types of MS: clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), primary progressive multiple sclerosis (PPMS), and secondary progressive multiple sclerosis (SPMS). Relapsing-remitting MS is the most common type, affecting 85% of people with multiple sclerosis.
Importance of Timely Diagnosis
Getting diagnosed with MS early can help you get treatment faster.This is important because your doctor will prescribe medications that can help reduce inflammation and slow disease progression once it’s confirmed that you have MS.
The symptoms that occur with MS are similar to other diseases and disorders, so getting tested can help rule out any other health conditions or infections. Conditions that can mimic MS include:
Tests
Your neurologist, a specialist in diseases and disorders of the nerves and nervous system, or other doctor will conduct a physical exam and ask about your symptoms. They will also order blood tests and imaging to rule out other conditions and diagnose MS.
Verywell / Laura Porter
Blood Tests
A blood test is used to help rule out conditions such as Lyme disease or other disorders that can be diagnosed with blood tests alone. The same goes for vitamin or mineral deficiencies.
MRI
Magnetic resonance imaging(MRI) uses radio waves and magnetic fields to get a clear picture of the inside of your body. Your doctor will order an MRI of the brain and spinal cord to look fordemyelination, which is damage to the myelin sheath.
The McDonald criteria use new lesions and lesions enhanced with gadolinium contrast medium to aid in MS diagnosis.However, it’s important to note that many people have white matter lesions associated with aging on other conditions that don’t represent MS.
Spinal Tap
The spinal tap also looks for a large number ofwhite blood cells, which are immune cells, and proteins known as oligoclonal bands. Oligoclonal bands are also antibodies that can indicate the body is experiencing a long-lasting overreaction from the immune system. A higher count of oligoclonal bands can help diagnose MS.
Roughly 5%–10% of people with MS will not have these abnormalities in their spinal fluid, though. That is why it is often used as a supplemental diagnostic tool.
Evoked Potentials
This test doesn’t determine if a person has MS on its own, but, in combination with other tests, it can help medical professionals reach a definitive diagnosis.
RecapThere is no one test that can diagnose MS, but when blood and imaging tests are used together, they can help doctors determine if you have MS.
There is no one test that can diagnose MS, but when blood and imaging tests are used together, they can help doctors determine if you have MS.
The McDonald criteria are the baseline for diagnosing MS. Updates were made in 2017 that changed the way MS is diagnosed. The McDonald criteria include one MS attack (a worsening of prior symptoms or brand-new symptoms that suddenly begin) and clinical evidence of one MS lesion, plus one criterion demonstrating dissemination in time and one criterion demonstrating dissemination in space.
Disseminated in time means that there is damage on different dates. If evidence of damage is disseminated in space, that means the damage is present in two or more parts of the central nervous system.
Each type of MS will have different results, and that is why the McDonald criteria address several situations that could occur at various stages of the disease. The criteria also contain a set of unique circumstances that go with each criterion to further assist in diagnosing the disease.
RecapThe McDonald criteria require the results of the examinations and tests to determine if the diagnostic criteria set out are met. The criteria take into account the number of lesions and flare-ups you have.
The McDonald criteria require the results of the examinations and tests to determine if the diagnostic criteria set out are met. The criteria take into account the number of lesions and flare-ups you have.
Since the diagnosis of MS typically relies on more than one test, as well as the pattern of each person’s disease, it can be hard to determine a timeline from when you first experience symptoms to when you are diagnosed. Often, it can take a few years for a person to be properly diagnosed if they have a progressive form of the disease.
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Monitoring of MS is often done following diagnosis to help keep track of how the disease is progressing over time. This is often done through repeat MRIs.MS can be highly unpredictable, so it’s important to keep the lines of communication open with your physician, live as healthily as possible, and continue with your treatment as prescribed.
RecapTo manage your MS, you will have to continue to monitor how it’s progressing and the ways it’s affecting your health and life. To do this, your doctors will likely ask you for routine testing and checkups to measure the progression of the disease as well as the efficacy of your specific treatment.
To manage your MS, you will have to continue to monitor how it’s progressing and the ways it’s affecting your health and life. To do this, your doctors will likely ask you for routine testing and checkups to measure the progression of the disease as well as the efficacy of your specific treatment.
Living With Multiple Sclerosis
Summary
Diagnosing MS can be difficult because there is no definitive way to tell if a person has it. Examining the results from an MRI, a spinal tap, blood tests, and evoked potentials (measurements of electrical activity in certain areas of the brain and spinal cord)against the McDonald criteria help doctors discern between MS and other diseases that can cause similar symptoms. Getting diagnosed early is vital for planning treatment and your future.
A Word From Verywell
Being diagnosed with MS can be a confusing and difficult time. Because the results of tests aren’t always cut-and-dried, the process between first experiencing symptoms and getting a treatment plan can be a long and arduous one. The good news is that once you finally reach a definitive answer, you can begin to plan for your future.
There will be follow-up appointments to keep track of your disease. In the majority of cases of MS, severe disability or death is rare. Maintaining a healthy lifestyle and adhering to your treatment plan can minimize disease progression and the impact MS have on your life.
Testing for MS involves a series of different strategies. There are several tools used such as MRIs, spinal taps, blood tests, and evoked potentials tests. For a proper diagnosis to occur, the results of each of these tests combined must fit a certain set of specific criteria known as the McDonald criteria. Only then can a person be diagnosed with MS.
Some of the early signs of MS can include double or blurry vision, numbness or tingling in the limbs or face, muscle stiffness and weakness, dizziness or vertigo, and clumsiness.Since these symptoms can occur for a variety of reasons, it’s best to make an appointment with your doctor if you are experiencing any of them. This can help you get to the bottom of why these symptoms are occurring, even if MS isn’t the cause.
Some of the early signs of MS can include double or blurry vision, numbness or tingling in the limbs or face, muscle stiffness and weakness, dizziness or vertigo, and clumsiness.
Since these symptoms can occur for a variety of reasons, it’s best to make an appointment with your doctor if you are experiencing any of them. This can help you get to the bottom of why these symptoms are occurring, even if MS isn’t the cause.
After you get diagnosed with MS, you and your medical team will formulate a treatment plan that works best for the type you have. You will also have to undergo sporadic monitoring tests to keep track of the progression of your disease.Having to start a new medication and repeat tests can be hard to cope with, but it is the best way to plan for your future and ensure that you live as healthily as possible for as long as you can.
After you get diagnosed with MS, you and your medical team will formulate a treatment plan that works best for the type you have. You will also have to undergo sporadic monitoring tests to keep track of the progression of your disease.
Having to start a new medication and repeat tests can be hard to cope with, but it is the best way to plan for your future and ensure that you live as healthily as possible for as long as you can.
16 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.Efendi H.Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management.Noro Psikiyatr Ars.2015 Dec;52(Suppl 1):S1-S11. doi:10.5152/npa.2015.12608Johns Hopkins Medicine.Relapsing-remitting multiple sclerosis.Goldenberg MM.Multiple sclerosis review.P T.2012 Mar;37(3):175-184.Johns Hopkins Medicine.Primary progressive multiple sclerosis.Johns Hopkins Medicine.Multiple sclerosis.Ghasemi N, Razavi S, Nikzad E.Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy.Cell J.2017 Apr-Jun;19(1):1-10. doi:10.22074/cellj.2016.4867National Multiple Sclerosis Society.Other conditions to rule out.Mantero V, Abate L, Balgera R, La Mantia L, Salmaggi A.Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis.J Clin Neurol. 2018;14(3):387-392. doi:10.3988/jcn.2018.14.3.387MedlinePlus.CSF Immunoglobulin G (IgG) index.Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK.The Cerebrospinal Fluid in Multiple Sclerosis.Front Immunol.2019 Apr 12;10:726. doi:10.3389/fimmu.2019.00726National Multiple Sclerosis Society.Cerebrospinal Fluid (CSF).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 Sep;23(10):1309-1319. doi:10.1177/1352458517707265National Multiple Sclerosis Society.Diagnostic workup.National Health Service.Multiple sclerosis diagnosis.Fox E. Melamed E. Frohman E.Diagnosis and Monitoring of Patients With Multiple Sclerosis.Practical Neurology.2018 July/August;32-38.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 May;30:51-56. doi:10.1016/j.msard.2019.01.048
16 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.Efendi H.Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management.Noro Psikiyatr Ars.2015 Dec;52(Suppl 1):S1-S11. doi:10.5152/npa.2015.12608Johns Hopkins Medicine.Relapsing-remitting multiple sclerosis.Goldenberg MM.Multiple sclerosis review.P T.2012 Mar;37(3):175-184.Johns Hopkins Medicine.Primary progressive multiple sclerosis.Johns Hopkins Medicine.Multiple sclerosis.Ghasemi N, Razavi S, Nikzad E.Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy.Cell J.2017 Apr-Jun;19(1):1-10. doi:10.22074/cellj.2016.4867National Multiple Sclerosis Society.Other conditions to rule out.Mantero V, Abate L, Balgera R, La Mantia L, Salmaggi A.Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis.J Clin Neurol. 2018;14(3):387-392. doi:10.3988/jcn.2018.14.3.387MedlinePlus.CSF Immunoglobulin G (IgG) index.Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK.The Cerebrospinal Fluid in Multiple Sclerosis.Front Immunol.2019 Apr 12;10:726. doi:10.3389/fimmu.2019.00726National Multiple Sclerosis Society.Cerebrospinal Fluid (CSF).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 Sep;23(10):1309-1319. doi:10.1177/1352458517707265National Multiple Sclerosis Society.Diagnostic workup.National Health Service.Multiple sclerosis diagnosis.Fox E. Melamed E. Frohman E.Diagnosis and Monitoring of Patients With Multiple Sclerosis.Practical Neurology.2018 July/August;32-38.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 May;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.
Efendi H.Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management.Noro Psikiyatr Ars.2015 Dec;52(Suppl 1):S1-S11. doi:10.5152/npa.2015.12608Johns Hopkins Medicine.Relapsing-remitting multiple sclerosis.Goldenberg MM.Multiple sclerosis review.P T.2012 Mar;37(3):175-184.Johns Hopkins Medicine.Primary progressive multiple sclerosis.Johns Hopkins Medicine.Multiple sclerosis.Ghasemi N, Razavi S, Nikzad E.Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy.Cell J.2017 Apr-Jun;19(1):1-10. doi:10.22074/cellj.2016.4867National Multiple Sclerosis Society.Other conditions to rule out.Mantero V, Abate L, Balgera R, La Mantia L, Salmaggi A.Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis.J Clin Neurol. 2018;14(3):387-392. doi:10.3988/jcn.2018.14.3.387MedlinePlus.CSF Immunoglobulin G (IgG) index.Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK.The Cerebrospinal Fluid in Multiple Sclerosis.Front Immunol.2019 Apr 12;10:726. doi:10.3389/fimmu.2019.00726National Multiple Sclerosis Society.Cerebrospinal Fluid (CSF).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 Sep;23(10):1309-1319. doi:10.1177/1352458517707265National Multiple Sclerosis Society.Diagnostic workup.National Health Service.Multiple sclerosis diagnosis.Fox E. Melamed E. Frohman E.Diagnosis and Monitoring of Patients With Multiple Sclerosis.Practical Neurology.2018 July/August;32-38.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 May;30:51-56. doi:10.1016/j.msard.2019.01.048
Efendi H.Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management.Noro Psikiyatr Ars.2015 Dec;52(Suppl 1):S1-S11. doi:10.5152/npa.2015.12608
Johns Hopkins Medicine.Relapsing-remitting multiple sclerosis.
Goldenberg MM.Multiple sclerosis review.P T.2012 Mar;37(3):175-184.
Johns Hopkins Medicine.Primary progressive multiple sclerosis.
Johns Hopkins Medicine.Multiple sclerosis.
Ghasemi N, Razavi S, Nikzad E.Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy.Cell J.2017 Apr-Jun;19(1):1-10. doi:10.22074/cellj.2016.4867
National Multiple Sclerosis Society.Other conditions to rule out.
Mantero V, Abate L, Balgera R, La Mantia L, Salmaggi A.Clinical application of 2017 McDonald diagnostic criteria for multiple sclerosis.J Clin Neurol. 2018;14(3):387-392. doi:10.3988/jcn.2018.14.3.387
MedlinePlus.CSF Immunoglobulin G (IgG) index.
Deisenhammer F, Zetterberg H, Fitzner B, Zettl UK.The Cerebrospinal Fluid in Multiple Sclerosis.Front Immunol.2019 Apr 12;10:726. doi:10.3389/fimmu.2019.00726
National Multiple Sclerosis Society.Cerebrospinal Fluid (CSF).
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 Sep;23(10):1309-1319. doi:10.1177/1352458517707265
National Multiple Sclerosis Society.Diagnostic workup.
National Health Service.Multiple sclerosis diagnosis.
Fox E. Melamed E. Frohman E.Diagnosis and Monitoring of Patients With Multiple Sclerosis.Practical Neurology.2018 July/August;32-38.
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 May;30:51-56. doi:10.1016/j.msard.2019.01.048
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