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Multiple Sclerosis Centers of Excellence

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Diagnosing Multiple Sclerosis

Lindsey Wooliscroft, MD -- Portland, OR

The diagnosis of MS is complex. The symptoms and clinical signs of MS often come and go, and symptoms are not the same for every person. A diagnosis of MS is not based on one specific physical finding, laboratory test, or symptom, but rather the appropriate combination of findings, tests, and symptoms with the appropriate time course. The diagnosis of MS in some people is quite quick, taking a few weeks, when the person has a very typical presentation. It may take months or even years, when a person’s presentation is less typical.

To make a diagnosis of MS, a healthcare provider will complete a thorough evaluation of the person’s history and perform a physical examination. A magnetic resonance image (MRI) of the brain is almost always also required. Additional testing, including MRI of the spinal cord, spinal fluid analysis, and visual evoked potential tests, as well as repeated neurological examinations and imaging over time, may also be needed to definitively make the diagnosis of MS.

Although many of the symptoms cannot be seen on examination, there are specific guidelines that have been developed to help a healthcare provider (usually a neurologist) make the diagnosis of MS. For a person to be diagnosed with MS, the healthcare provider must:

  1. Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord, and optic nerves. AND
  2. Find evidence that the damage occurred at least one month apart. Sometimes, spinal fluid abnormalities consistent with MS can be used to make this determination. AND
  3. ALSO, all other possible diagnoses must be ruled out.

Symptoms of MS often mimic those of other diseases. Ruling out any other condition is an important part of the diagnostic process. Although this may take time, it’s important that the proper diagnosis is given so that the best treatment options can be selected for the disease. The VA is committed to providing Veterans the specialized services and testing needed to establish an accurate diagnosis of MS.

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