Early Diagnosis of Multiple Sclerosis: Difficult But Important

How can multiple sclerosis be diagnosed early when treatment may best prevent damage to the brain and spinal cord? The short answer is: "With difficulty."

The major dilemma in the current management of multiple sclerosis is that while early diagnosis makes it possible to begin anti-damage treatment, diagnosing MS too early increases the chances of treating people who do not actually have the disease. . Current disease-modifying drugs are given by injection and cost about $14,000 a year. In addition to being inconvenient and expensive, they also carry some risk of harm, which, if the patient does not actually have MS, is without any offsetting benefit.

 

If multiple sclerosis were easier to diagnose the dilemma would not be as great, but unfortunately MS is one of the most difficult diagnoses in all of medicine, at least still in its early stages. At the onset of symptoms, MS may resemble other conditions; Additionally, other conditions may resemble MS.

 

Affecting 2.5 million people worldwide and 350,000 in the US alone, multiple sclerosis is actually not a rare disease. It affects women at least twice as often as men and begins in early adulthood, with most cases beginning between the ages of 20 and 40.

 

MS is a so-called autoimmune disease, which means that a person's immune system – usually useful and necessary in fighting infection – becomes overactive and attacks the person's own body tissues. Rheumatoid arthritis is another example of an autoimmune disease, but in MS the immune attack is not directed against the joints as it is in rheumatoid arthritis. Instead, the immune system typically attacks large groups of nerve fibers within the central nervous system that includes the brain and spinal cord.

 

These attacks can cause a variety of symptoms, depending on the normal function of the nerve fibers being attacked. When the attack on nerve fibers is related to vision, the symptoms are visual, such as loss of visual clarity or even doubling of vision. When nerve fibers are involved in the process of physical sensation, symptoms may include numbness or tingling. In fact, visual or sensory symptoms are the most common early symptoms in multiple sclerosis. But early symptoms may include dizziness, weakness, clumsiness or difficulty urinating. The wide variety of initial symptoms caused by multiple sclerosis is one of the main difficulties in recognizing and properly diagnosing it.

 

In this regard it is useful to consider the twin issues of “false-positive” and “false-negative”. In short, every medical test and every diagnosis is subject to these errors. False-positive means that a test or doctor indicates that a disease is present when, in fact, it is absent. A false-negative error occurs when a test or doctor indicates that a disease is absent when it is actually present. Despite increasing medical knowledge and the confidence provided by more and more sophisticated tests, false-positives and false-negatives are a fact of life and still apply to every test and every diagnosis.

There are three cornerstones of the diagnostic process in multiple sclerosis. In general descending order of importance they are clinical assessment, magnetic resonance imaging (MRI) scanning and examination of cerebrospinal fluid. Each of these is important in its own way, but one component almost never stands on its own merits, requiring one or both of the other components for validation.

 

Clinical evaluation refers to the time-honored process in which the physician obtains a history of symptoms and performs a physical examination. The physical examination primarily consists of neurological testing, which is a battery of mini-tests that gauge the performance of various components of the nervous system.

 

Even a high-tech and powerful test like an MRI scan can lead to diagnostic errors. False-positive results often occur when a patient undergoes a scan for a completely unrelated reason — like a headache, for example — and there is a pocket of increased signal within the brain that the radiologist attributes to multiple sclerosis. When abnormal scans lead to consultation with a neurologist, the neurologist often determines that multiple sclerosis is out of the question, and the areas of increased signal are either benign or due to some other problem entirely. . MRIs for multiple sclerosis often produce false-negative results, but nevertheless, this imaging test represents only the tip of the iceberg in this disease, failing to demonstrate the significant changes occurring at the microscopic level.

 

Examination of cerebrospinal fluid (CSF) is another valuable tool in the diagnosis of MS. CSF bathes the inside and outside of the brain and the exterior of the spinal cord, so its cellular and chemical composition often reflects what is going on within those structures. CSF is obtained via lumbar puncture, also known as a spinal tap, a safe procedure in which a needle is inserted through the lower back and into the CSF space. The fluid collects as it drips past the needle. Cases of active MS usually have abnormal proteins produced by the immune system that can be detected and measured in the CSF. However, there are also false-positives and false-negatives, so some people with the abnormal protein do not get MS and other people with the normal protein still have the disease.

 

Therefore the diagnostic process – which includes clinical assessment, MRI scanning, and CSF examination – is fraught with the potential for error at every step of the way. Yet there is considerable incentive to diagnose the disease as early as possible (this is also when the risk of diagnostic errors is greatest) so that treatments can be initiated that control an out-of-control immune system. Filtering the clinical information to make a timely and accurate diagnosis almost always requires the assistance of a neurologist, and even with the help of these specialists in nervous system disorders, the diagnosis is sometimes modified as time passes. is done and the clues become more definite.

 

FAQs

What is multiple sclerosis?

The term multiple sclerosis refers to multiple areas of scarring (sclerosis) that result from the destruction of the tissues that wrap around nerves (myelin sheaths) in the brain and spinal cord.

 

 

Does multiple sclerosis cause headache?

What is Multiple Sclerosis?

In MS, myelin gets damaged. In this, a spot is formed near the lateral ventricles of the brain (where cerebrospinal fluid accumulates), due to which cases of attack occur.

 

 

How early can multiple sclerosis be detected?

MS can appear at any age but most commonly occurs between the ages of 20 and 40.

 

 

How long can you have multiple sclerosis without knowing?

The study found that later-onset patients often had prodromal symptoms, such as fatigue and general weakness, five to 10 years before they were diagnosed with MS.

 

 

What is the best treatment for multiple sclerosis?

Beta interferons: These are some of the most common medications used to treat MS. They make flare-ups less frequent and less severe. They can also cause flu-like symptoms, such as aches, fatigue, fever, and chills, but these should resolve within a few months.