What tests are used for multiple sclerosis?
There’s a bewildering variety of tests to undergo (or endure) when you visit your neurologist’s office. Here’s a summary of the main procedures and what they tell your doctor.
History: Your doctor will ask you questions about your past and present symptoms (tingling, muscle weakness, etc.). It’s important to be as accurate as you can because the frequency and severity of your relapses are good indicators of how active your MS is. A detailed description of your symptoms will also help your doctor rule out conditions that can mimic MS.
Neurological exam: Your neurologist needs to assess your nerve function to determine what areas of the brain and spinal cord are affected, and the severity of your symptoms. The functions that are tested are motor (muscle movement and strength), sensory (e.g. pain and sense of touch), brainstem (e.g. eye movements), cerebellar (e.g. muscle control, balance), visual (sight), and cognitive (concentration, speech, etc.).
Tests include seeing how well and how far you can walk, and reflex tests, such as the knee jerk and the triceps jerk (just above the elbow). With the plantar reflex test, when the sole of your foot is stimulated, your big toe normally flexes down; if it flexes up (called the Babinski sign), it’s a sign of nerve dysfunction. Vibrating a tuning fork on the big toe is done to determine if you have altered sensation. Your doctor will also move a finger or pen across your line of vision to see how well your eyes track the movement. Jerky eye movements (nystagmus) indicate a problem in the brainstem. For the Romberg test, you stand with your feet together and close your eyes. If you begin to fall, this indicates a cerebellar problem.
These tests are sufficient to diagnose MS. But doctors will typically use one or more “paraclinical” tests to confirm the diagnosis. The two main tests are MRI and spinal tap (lumbar puncture).
MRI: Magnetic resonance imaging allows your doctor to see inflammation in the brain and spinal cord. There are certain patterns and locations of inflammatory lesions that are characteristic of MS.
Spinal tap: This is the most painful test you’ll have to undergo. A needle is injected into the space between two vertebrae and a sample of cerebrospinal fluid (CSF) is taken. This is analysed for the presence of immune cells or antibodies (called oligoclonal bands, or OCBs), which indicate immune activation in your central nervous system. OCBs are found in about 80-90% of people with MS (Dobson et al. J Neurol Neurosurg Psychiatry 2013;84:909-914). With the more widespread use of MRI, many doctors have stopped performing spinal taps. But recent studies have shown that this test is important in its own right. Test results can help predict who has a higher risk of more aggressive disease and early disability progression (Villar et al. Clin Immunol 2010;137:51-59). Researchers are also examining whether a protein (called neurofilaments) found in the CSF of people with MS can be used to quantify the amount of damage that’s going on in the brain and spinal cord. Preliminary studies with Tysabri and Gilenya have suggested that treatment can lower the amount of neurofilament, suggesting that these medications may be reducing the amount of tissue damage in the brain (Kuhle et al. Acta Neurol Scand 2013;128:e33-36; Kuhle et al. ECTRIMS 2013, abstract 233). These results need to be confirmed. But the good news is that neurofilaments may serve as a good marker of the effectiveness of MS medications. The bad news, of course, is that more doctors will go back to performing spinal taps.
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