Diagnosing Multiple Sclerosis: Beyond Symptoms Alone

MS cannot be diagnosed on symptoms alone—they overlap with many neurological conditions. Diagnosis requires a combination of clinical, imaging, and laboratory findings per the McDonald Criteria.

Diagnostic Workup

1. Clinical History & Neurological Exam

Assesses dissemination of lesions in space (different CNS areas) and time (separate episodes).

2. MRI (Brain & Spinal Cord)

Gold standard. Shows demyelinating plaques (T2/FLAIR hyperintensities) in characteristic locations: periventricular, juxtacortical, infratentorial, spinal cord.

3. Cerebrospinal Fluid (CSF) Analysis

Oligoclonal bands (OCBs) present in CSF but not serum = intrathecal IgG synthesis (95% sensitivity for MS).

4. Evoked Potentials

Visual (VEP), brainstem auditory (BAEP), or somatosensory (SSEP) reveal subclinical demyelination.

5. Optical Coherence Tomography (OCT)

Measures retinal nerve fiber layer thinning—supports diagnosis and monitors neurodegeneration.

Key Principle

No single test confirms MS. A neurologist integrates all data to exclude mimics (NMOSD, MOGAD, migraine, vascular, infectious, metabolic).