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Diagnosis

How is MS diagnosed?

You will be referred to a neurologist who will look at your medical history and examine you. You are then likely to undergo a number of tests including:

Magnetic Resonance Imaging (MRI) Scan

This will identify any areas of the brain or spinal cord that may have lesions.

Lumbar Puncture

A lumbar puncture (also known as a spinal tap) is used to take a sample of spinal fluid to test for abnormalities.

Evoked Potentials

These are simple tests that measure the time it takes for the nerves to respond to electrical stimulation.

A positive diagnosis can take some time and these tests are not always conclusive. We are here though, every step of the way, to support you emotionally and offer you as much information as you would like.

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Questions to ask your health professional

Here is a list of questions you could ask your health professional about multiple sclerosis, including questions about medication and treatment options.

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The McDonald Diagnostic Criteria

The McDonald criteria are used to seek to establish evidence of damage to the central nervous system (CNS) comprising of the brain and spinal cord.

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What causes MS?

Although it is not yet certain why people develop MS, current research suggests that a combination of genetic and environmental factors are involved.

We know that MS is an autoimmune disease, where a fault develops and the immune system begins attacking itself. It is thought that immune cells (T cells) mistake myelin, the fatty coating that protects nerves in the brain and spinal cord, for a foreign invader. This autoimmune attack is believed to occur through a process called molecular mimicry, during which part of a molecule in a given protein ‘mimics’ part of another totally different protein. The immune system thinks it is attacking a foreign body, when in actual fact it is attacking its own tissue.

Genetic factors

While MS is not directly inherited there does appear to be a genetic component – possibly a combination of certain genes – which makes some people more susceptible. Family members of someone diagnosed with MS have a slightly higher chance of developing MS themselves compared to people who have no history of MS in their family.

MS is not passed from parent to child and therefore is not classed as a genetic or hereditary illness. Even where one identical twin has MS, there is only a 20 to 30 per cent chance that the second twin will also develop MS. However, if you have a family member with MS, your risk of developing the condition rises from around 1 in 1000 to around 1 in 50. Even where there are genetic predispositions it is thought that environmental factors still increase susceptibility.

Environmental factors

These are factors concerning the way in which we live and where we live. For example, current research shows people who live near the equator are thought to be less susceptible to MS and it is thought this could be due to the amount of sunshine they are exposed to and the corresponding increase in levels of vitamin D. Reported cases of MS are highest in the Northern States of the US, Canada, Northern Europe, New Zealand and Tasmania.

Scientists are also studying areas where clusters of cases have appeared but as yet have not identified any common factors that might trigger MS or give rise to an increase in susceptibility. As well as where we live, diet, stress, trauma, nutrition and hormones may also play a part in the development of the condition.

Some research suggests that there is a link between MS and vitamin D deficiency. Vitamin D mostly comes from exposure to sunlight. Research about this connection is ongoing.

Viruses

The cause of MS is not understood, but it is thought that a combination of genetic factors increase susceptibility and then a trigger, such as an infection or another environmental factor, causes the condition to develop. Work has been done into whether certain viruses can trigger the onset of multiple sclerosis. Some research implicates the virus that causes glandular fever – the Epstein-Barr (or human herpes) virus – in the development of MS.

However, the association between this virus and MS is not yet clear. It must be remembered that the Epstein-Barr virus is very common; many people are exposed to it and only a very small percentage will go on to develop MS. Scientists are trying to understand whether the virus has a direct effect on the condition or whether it may trigger other factors in the onset of autoimmune disease. Despite the work that has been done on Epstein-Barr and other viruses, scientists have yet to produce conclusive results that demonstrate a direct relationship between a virus of any type and the development of MS.

Is it MS?

There are numerous conditions which exhibit similar symptoms to multiple sclerosis such as Hughes Syndrome, Lupus and Chronic Fatigue Syndrome. Find out more about these conditions in our Choices leaflet below.

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Symptom diary

Whether you have MS or are in the early stages of gaining a diagnosis, it can be useful to keep track of your symptoms. Keeping a regular symptom diary may help you to spot any patterns, keep note of any triggers and may be useful for when you have meetings with your health professionals. Appointments with your GP or a neurologist can be very time limited and capturing and recording your symptoms in this way may help the meeting go smoothly and ensure you have been able to tell the health professionals about all the issues you have been facing. If you have a diagnosis of MS using this diary may be useful to establish if any treatment is working for you or if your MS is changing over time.

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Am I having a relapse?

This form contains information about what the clinical criteria for diagnosing a relapse is. It also includes a chart for completing that may help you identify any external factors that may be influencing your health and a version of our symptom diary for recording symptoms that have occurred during your potential relapse. If you are concerned that you are having a relapse it is important to inform your GP, MS nurse or neurologist about your symptoms, so they can offer advice and treatment if necessary.

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