How Is Multiple Sclerosis Diagnosed?

MS的症状是什么？

The CNS acts as the communication center in your body. It sends signals to your muscles to make them move, and the body transmits signals back for the CNS to interpret. These signals could include messages about what you’re seeing or feeling, such as touching a hot surface.

On the outside of the nerve fibers that carry signals is a protective casing called myelin (MY-uh-lin). Myelin makes it easier for nerve fibers to transmit messages. It’s similar to how a fiber-optic cable can conduct messages faster than traditional cable.

When you have MS, your body attacks myelin and the cells that make myelin. In some cases, your body even attacks the nerve cells.

MS symptomsvary from person to person. Sometimes, symptoms will come and go.

Doctors associate some symptoms as being more common in people living with MS. These include:

• 膀胱和肠功能障碍
• 沮丧
• difficulty thinking, such as affected memory and problems focusing
• difficulty walking, such as losing balance
• dizziness
• fatigue
• numbness or tingling of the face or body
• pain
• muscle spasticity
• vision problems, including blurred vision and pain with eye movement
• weakness, especially muscle weakness

Less common MS symptoms include:

• breathing problems
• 头痛
• hearing loss
• itching
• problems swallowing
• seizures
• speaking difficulties, such as slurred speech
• tremors

If you have any of these symptoms, talk to your doctor.

What is the process for diagnosing MS?

MS isn’t the only condition that results from damaged myelin. There are other medical conditions your doctor may consider when diagnosing MS that could include:

• 自身免疫性疾病, like collagen vascular disease
• exposure to toxic chemicals
• Guillain-Barré syndrome
• hereditary disorders
• viral infection
• vitamin B-12 deficiency

Your doctor will start by requesting your medical history and reviewing your symptoms. They will also perform tests that can help them assess your neurological function. Your neurological evaluation will include:

• testing your balance
• watching you walk
• assessing your reflexes
• testing your vision

Blood testing

Your doctor may also order blood tests. This is to rule out other medical conditions and vitamin deficiencies that could be causing your symptoms.

Evoked potential tests

Evoked potential (EP) tests are those that measure the brain’s electrical activity. If the test shows signs of slowed brain activity, this could indicate MS.

Testing EP involves placing wires on the scalp over specific areas of your brain. You’ll then be exposed to light, sounds, or other sensations while an examiner measures your brain waves. This test is painless.

尽管有几种不同的EP测量值，但最接受的版本是Visual EP。这涉及要求您查看显示交替的棋盘格式的屏幕，而医生则测量大脑的反应。

Magnetic resonance imaging (MRI)

Magnetic resonance imaging（MRI）可以显示MS诊断特征的大脑或脊髓中的异常病变。在MRI扫描中，这些病变将显得明亮的白色或非常黑暗。

Because you can have lesions on the brain for other reasons, like after having a stroke, your doctor must rule out these causes before making an MS diagnosis.

一个n MRI doesn’t involve radiation exposure and isn’t painful. The scan uses a magnetic field to measure the amount of water in the tissue. Usually myelin repels water. If a person with MS has damaged myelin, more water will show up in the scan.

Lumbar puncture (spinal tap)

此过程并不总是用于诊断MS。但这是潜在的诊断程序之一。一个lumbar punctureinvolves inserting a needle into the spinal canal to remove fluid.

一个laboratory professional tests the spinal fluid for the presence of certain antibodies that people with MS tend to have. The fluid can also be tested for infection, which could help your doctor rule out MS.

Diagnostic criteria

Doctors may have to repeat diagnostic tests for MS several times before they can confirm the diagnosis. This is because MS symptoms can change. They may diagnose someone with MS if testing points to the followingcriteria:

• 体征和症状表明中枢神经系统中的髓磷脂受损。
• 医生已经确定至少两个或两个以上的莱斯ions in two or more parts of the CNS via an MRI.
• There’s evidence based on a physical exam that the CNS has been affected.
• 一个person has had two or more episodes of affected neurological function for at least one day, and they occurred a month apart. Or, a person’s symptoms have progressed over the course of one year.
• The doctor can’t find any other explanation for the person’s symptoms.

Diagnostic criteria have changed over the years and will likely continue to change as new technology and research comes along.

最新的接受标准于2017年发布了。 McDonald Criteria. 多发性硬化症诊断的国际小组发布了这些标准。

One of the more recent innovations in diagnosing MS is a tool called optical coherence tomography (OCT). This tool allows a doctor to obtain images of a person’s optical nerve. The test is painless and is much like taking a picture of your eye.

医生知道，患有MS的人倾向于具有与没有这种疾病的人不同的视神经。OCT还允许医生通过查看视神经来跟踪人的眼睛健康。

每种MS类型的诊断过程是否不同？

Doctors have identified a number of MS types. In 2013, the International Advisory Committee on Clinical Trials of MS revised the descriptions of these types based on new research and updated imaging technology.

一个lthough the diagnosis of MS has initial criteria, determining the MS type a person has is a matter of tracking a person’s MS symptoms over time. To determine the type of MS a person has, doctors look for

• MS activity
• 缓解
• progression of the condition

The types of MS include:

Relapsing-remitting MS

It’s estimated that85％of people with MS are initially diagnosed withrelapsing-remitting MS, which is characterized by relapses. This means new MS symptoms appear and are followed by a remission of the symptoms.

一个bout half of the symptoms that occur during relapses leave some lingering problems, but these may be very minor. During a remission, a person’s condition doesn’t get worse.

主要进行性MS

The National MS society estimates that15 percent有MS的人有primary progressive MS. Those with this type experience a steady worsening of symptoms, usually with fewer relapses and remissions early in their diagnosis.

Secondary progressive MS

具有这种MS类型的人患有早期复发和缓解的事件，随着时间的流逝，症状会恶化。

Clinically isolated syndrome (CIS)

一个doctor may diagnose a person withclinically isolated syndrome(CIS) if they have an episode of neurologic symptoms associated with MS that lasts at least 24 hours. These symptoms include inflammation and damage to myelin.

Having just one episode of experiencing a symptom associated with MS doesn’t mean a person will go on to develop MS.

However, if the MRI results of a person with CIS show that they might be at higher risk for developing MS, the new guidelines recommend starting disease-modifying therapy.

Takeaway

一个ccording to theNational MS Society, these guidelines have the potential to reduce the onset of MS in people whose symptoms are detected in the very early stages.