How is multiple sclerosis diagnosed?

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To receive a diagnosis of MS, a person must meet three criteria:

• There must be evidence of MS-related lesions or damage in two separate areas of the central nervous system, which includes the brain, spinal cord, and optic nerves.
• There must be evidence that the damage occurred at two different times.
• There must be no other diagnosis — such as a head injury or cancer — that could explain the damage.

The right combination of tests for MS depends on a person’s symptoms and whether they have risk factors for other diseases. The diagnostic process might involve:

• Complete medical history: A doctor will ask about the person’s medical history, including their family medical history. They may ask about the person’s environment, as exposure to certain poisons may damage the nervous system. The doctor will also ask when the symptoms first appeared and how they have changed with time.
• Blood test: A blood test cannot prove that a person has MS, but it can rule out other problems, such as nutritional deficiencies, certain infections, and some genetic disorders.
• Neurological exam: A doctor will test to see how well the neurological system is working by assessing balance, reflexes, coordination, strength, swallowing ability, and how well the senses are working.
• MRI: MRI uses magnets to produce an image of the brain, spinal cord, and, sometimes, other parts of the body. These images can show MS-related damage. The individual will need to sit in a loud machine for the test.
• Lumbar puncture: A lumbar puncture tests the cerebrospinal fluid (CSF) for certain changes that often occur with MS, such as an increase in proteins called oligoclonal bands, or OCBs. However, 5–10% of people with MS do not show abnormal CSF. Some CSF changes are also present in other diseases, so a lumbar puncture only works when a doctor uses it alongside other tests.
• Visual evoked potential (VEP): A VEP test records how signals move through the nervous system. A doctor uses electrodes on the head and back to measure these signals. If the signals move too slowly, this may indicate damage to the myelin. This damage is a sign of MS, but other tests are still necessary to confirm a diagnosis.

The right treatment will depend on a person’s symptoms, overall health, and response to treatment. Some people have to try several different treatment regimens to find one that works for them. Some treatment options include:

• Disease-modifying drugs (DMDs): These medications can stop new damage to the myelin and potentially slow or even halt the progression of MS.
• Medications to manage symptoms: Several medications can manage MS flares. For example, a doctor might prescribe pain relievers, medications to help with spasms or nerve pain, or antidepressants to manage symptoms.
• Physical therapy: Physical therapy and exercise may help improve coordination and balance, minimizing the risk of falls.
• Psychological support: Support groups, therapy, and similar options may help people deal with brain fog and the psychological challenges of MS.

There is no cure for MS, but treatment can be very effective in managing symptoms. The right DMD can prevent new symptoms from occurring if a person starts taking it at an early stage of the disease.

MS happens when the body’s immune system attacks healthy tissue — specifically, the myelin that coats part of the nerve cells. Doctors do not fully understand why this happens, but some theories include:

• Genetics: There is no specific gene that causes MS or always passes from parent to child in a predictable fashion. However, MS may be more common in certain families. The risk that a person will have MS if their twin has it is 1 in 4, suggesting that both genetic and environmental factors play a role.
• Geographic location: MS is more prevalent in areas further from the equator. It is possible that early exposure to some harmful factors that are more prevalent in these areas, such as viruses or vitamin D deficiency, increases the risk.
• Infections: Doctors think that exposure to some infectious agents, such as the Epstein-Barr virus, may change the immune system and increase the risk of developing MS.
• Environmental and lifestyle factors: Smoking increases the risk of developing MS, as does vitamin D deficiency. Childhood obesity also correlates with a higher likelihood of having MS in adulthood.

Many of the symptoms that MS causes also occur with other diseases, making MS challenging to diagnose. Moreover, some people with early MS may have very few symptoms. When symptoms do occur, they include:

• unexplained fatigue
• brain fog
• weakness
• numbness or tingling in one part of the body
• muscle spasms
• muscle pain
• double vision
• blurred vision in one eye
• eye discomfort in one eye when looking in certain directions

Some natural remedies may help with MS, but they cannot replace standard treatments. They include:

• supplements for people with nutritional deficiencies
• exercise, especially relaxing exercises such as yoga
• acupuncture

Good nutrition is important for managing any disease. Some people report improvements with certain diets, but there is no compelling scientific evidence showing that a specific diet improves symptoms in all or most people.

Learn more about diet tips for MS here.

Multiple sclerosis is a chronic illness with no known cure. It often gets worse with time if a person does not start on an effective treatment regimen at an early stage. However, doctors can now slow the course of the disease with medication, which can also relieve symptoms.

Therefore, anyone who has signs and symptoms of MS should speak with a doctor as soon as possible. A person with a confirmed diagnosis should seek medical advice if their treatment stops working.

No single test can confirm a diagnosis of MS. Instead, doctors must perform multiple diagnostic tests to eliminate other possible causes of the symptoms.