The adage “things aren’t always what they seem” rings particularly true when it comes to making an MS diagnosis. One reason for the uncertainty is that the symptoms of multiple sclerosis, such as vision problems, imbalance, brain fog, pain, spasticity and fatigue, can mirror those of other medical conditions, like lupus, Lyme disease, fibromyalgia and even vitamin B deficiency, among others. On top of that, doctors need more than one test to make a firm diagnosis, and so far none of the available procedures are 100 percent accurate.
In fact, according to a survey published online in May 2012 in the journal Neurology, 95 percent of the 122 doctors in the study who treated MS sufferers said they had encountered at least one misdiagnosed patient during the year, and 40 percent said they had encountered at least three to five patients misdiagnosed during the same 12-month period.
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“Sometimes doctors diagnose MS but it’s really a different disease, and sometimes multiple sclerosis is present and it’s not picked up,” says Dr. Roumen Balabanov, a neurologist at Chicago’s Northwestern Memorial Hospital. “That’s too bad because the earlier the treatment for the disease, the more likely it is that a patient can begin modifying medications to reduce the number and severity of relapses [also known as flare-ups].”
What’s the upside? There are new tests on the horizon, as well as substantial improvements with classic procedures. Both increase the opportunities for making a faster and more accurate diagnosis of the disease. Today, the primary diagnostic tool doctors offer is magnetic resonance imaging. It uses radio waves and magnetic fields to evaluate tissues in the body. It works because MS attacks the protective tissues called the myelin sheath around the nerves of the brain and spinal cord, leaving lesions (or scarring) in its wake. An MRI can spot these lesions. But there’s a Catch-22. There are common conditions that also cause lesions in the same area, such as infection or injury.
Balabanov says the MRI has made a big leap in refining its results. “Originally we had to see nine lesions based on something called the MacDonald Criteria, but within the last few years, it’s been revised, and now we only need to identify four lesions in specific locations to fulfill the criteria and make a diagnosis of multiple sclerosis,” he says. “Presently, the MRI has a 70 to 80 percent accuracy rate.”
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The other most commonly used diagnostic test is a spinal tap (also known as “lumbar puncture”). The test involves removing a sample of the patient’s cerebrospinal fluid, a liquid that protects and cushions the brain and spinal cord. “Presence of one or more oligoclonal bands [these are bands of immunoglobulins or proteins] tells us there is some inflammation in the central nervous system due to either infection or an autoimmune disease like MS,” explains Dr. Michael Racke, a neurologist at the Ohio State University Wexner Medical Center. But that’s still not the whole picture. “We then have to look at the patient’s blood. If similar bands are not found, there’s a 95 percent probability the patient has MS.”
Another diagnostic technique is called Evoked Potential. EP is less invasive, takes only around 45 minutes to administer, and except for a very slight discomfort caused by a mild shock, it’s relatively painless. A technician makes a recording of a patient’s central nervous system’s electrical response to the stimulation of particular nerve pathways (visual, auditory and sensory) that are commonly affected in MS. Since damage to the myelin sheath results in a slowing of response time, EPs can help provide evidence of demyelination along particular nerve pathways that may not be apparent to the neurologist with any other type of examination. But here’s the hitch: Other conditions besides MS can cause slowing down of responses, such as a brain tumor.
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“The goal is for medical researchers to develop less invasive tools to identify MS patients earlier with a higher degree of accuracy,” Racke says. Right now, that appears to be a tall order. But scientists at Michigan State University are making the climb. They’re looking at a simple blood test that can distinguish the biomarkers in blood found in patients with MS and those with other neurological diseases. A study reported in 2016 in the journal EbioMedicine shows that the blood test holds real promise. If it works, it will be easier, faster and less expensive to make an initial diagnosis of MS. But it’s not quite there yet. “So far it’s only been tested on a very small sample of less than 200 people,” Racke says. “Further research needs to be undertaken to see if the biomarkers are reliable.”
Although there’s still no magic bullet yet, Racke remains hopeful. “Everyday researchers are making progress towards developing a better way to diagnose MS — and that will be giant step. ”
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What New Diagnostic Tests Might Be Available for MS Soon? originally appeared on usnews.com
