Multiple Sclerosis

Diagnosis

There is no single test that can definitively diagnose multiple sclerosis. Health care professionals make the diagnosis by combining medical history, a physical and neurological exam, imaging studies, and laboratory results. Part of the diagnostic process also involves ruling out other conditions that can cause similar symptoms, known as a differential diagnosis.

Neurological exam
A neurological examination checks how well the nervous system is working. This may include testing muscle strength, coordination, balance, vision, sensation, and reflexes such as knee reflexes. Findings can help identify areas of nerve damage.

MRI
Magnetic resonance imaging is one of the most important tools used to diagnose multiple sclerosis. MRI scans can reveal areas of damage in the brain and spinal cord called lesions.
Sometimes a contrast dye is given through an IV to highlight lesions that indicate active inflammation.

Lumbar puncture
A lumbar puncture, also called a spinal tap, involves removing a small sample of cerebrospinal fluid from the spinal canal for laboratory testing. The fluid may show changes in antibodies linked to multiple sclerosis.
This test can also help rule out infections or other neurological conditions. A newer antibody test that checks for kappa free light chains may provide faster and less expensive results than older spinal fluid tests.

Optical coherence tomography
Optical coherence tomography uses light waves to create detailed images of the eye. In multiple sclerosis, inflammation of the optic nerve, known as optic neuritis, can cause changes in the retina. This test measures retinal thickness and can detect nerve fiber damage.

Evoked potential tests
Evoked potential tests measure the electrical signals produced by the nervous system in response to stimuli. Visual or electrical stimuli are used while electrodes record how quickly signals travel through nerve pathways. Slower responses can indicate nerve damage related to multiple sclerosis.

Blood tests
Blood tests cannot diagnose multiple sclerosis directly, but they help rule out other diseases with similar symptoms. Research is ongoing to identify specific biomarkers that may help support the diagnosis in the future.

Neuropsychological testing
Neuropsychological testing evaluates how the brain is functioning. It examines memory, thinking, language, mood, personality, and social skills.
This testing is important because many people with multiple sclerosis experience cognitive impairment that can affect daily life. A baseline test may be done after diagnosis, with repeat testing over time to monitor changes.

Diagnosis in different forms of MS
In most people with relapsing-remitting multiple sclerosis, diagnosis is straightforward and based on typical symptom patterns confirmed by test results.
Diagnosis can be more challenging in people with unusual symptoms or progressive forms of the disease, and additional testing may be required.

Treatment

There is no cure for multiple sclerosis. Treatment focuses on speeding recovery from attacks, reducing relapses, slowing disease progression, and managing symptoms. Some people with very mild symptoms may not need treatment.

Treatments for MS attacks

During an MS relapse, treatment may include:

Corticosteroids
Corticosteroids such as oral prednisone or intravenous methylprednisolone help reduce nerve inflammation. Possible side effects include insomnia, mood changes, increased blood pressure, elevated blood sugar levels, and fluid retention.

Plasma exchange
Plasma exchange, also called plasmapheresis, involves removing plasma from the blood and replacing it with albumin before returning the blood to the body. This treatment may be used for severe attacks that do not respond to corticosteroids.

Treatments to modify disease progression

Disease-modifying therapies work to reduce relapses, slow disease progression, and limit new lesion formation. These therapies are especially effective when started early in the disease.

Choosing the right therapy depends on factors such as disease type, duration, severity, prior treatment response, overall health, cost, and future pregnancy plans.

Treatment options for relapsing forms of multiple sclerosis include injectable, oral, and infusion medicines.

Injectable treatments
Examples include interferon beta medicines, which reduce inflammation and relapse frequency, and glatiramer acetate, which helps block immune attacks on myelin. Other injectable options target specific immune cells involved in nerve damage.

Oral treatments
Oral medicines can reduce relapse rates and slow progression. These treatments vary in dosing schedules, side effects, and monitoring requirements. Some may increase the risk of infections, liver problems, or birth defects, so regular blood tests and pregnancy prevention may be necessary.

Infusion treatments
Infusion therapies are given through an IV and often target specific immune cells or pathways involved in multiple sclerosis. These medicines can be very effective but may carry serious risks, including infections or immune-related complications, and require close medical monitoring.

Treatments for MS symptoms

Managing symptoms is an important part of multiple sclerosis care and can improve quality of life.

Therapy
Physical and occupational therapy can help improve strength, balance, and mobility. Therapists also teach exercises and recommend tools to make daily activities easier.

Muscle relaxants
Medicines may be prescribed to reduce muscle stiffness or spasms. In some cases, injections may be used to help control severe muscle contractions.

Medicines for fatigue
Several medicines have been used to help manage fatigue related to multiple sclerosis, though results vary and side effects may occur. Some antidepressants may also be helpful.

Medicines to improve walking
Certain medicines may slightly improve walking speed in some people. These medicines are not suitable for everyone and may cause side effects such as dizziness or urinary infections.

Other symptom treatments
Medicines may also be prescribed to manage pain, depression, sexual dysfunction, sleep problems, and bladder or bowel control issues related to multiple sclerosis.

Emerging and experimental therapies

Research into new multiple sclerosis treatments is ongoing.

BTK inhibitors
Bruton’s tyrosine kinase inhibitors are being studied for relapsing-remitting and secondary-progressive multiple sclerosis. These medicines affect B-cell activity in the central nervous system.

Stem cell transplantation
Stem cell transplantation aims to reset the immune system by destroying it and rebuilding it with healthy stem cells. Researchers are studying whether this approach can reduce inflammation and disease activity.

Targeted immune therapies
New treatments are being developed to block specific immune proteins involved in multiple sclerosis, reduce inflammation, and limit nerve damage.

Ongoing research continues to improve understanding of how therapies reduce relapses and brain lesions, and whether treatment can delay long-term disability.