The list of medical tests mentioned in various sources as used in the diagnosis of Multiple Sclerosis includes:
Physicians use a neurological examination and take a medical history when they suspect MS. Imaging technologies such as MRI, which provides an anatomical picture of lesions, and MRS (magnetic resonance spectroscopy), which yields information about the biochemistry of the brain. Physicians also may study patients' cerebrospinal fluid and an antibody called immunoglobulin G. No single test unequivocally detects MS. A number of other diseases produce symptoms similar to those seen in MS. (Source: excerpt from NINDS Multiple Sclerosis Information Page: NINDS)
The following medical news items are relevant to diagnosis and misdiagnosis issues for Multiple Sclerosis:
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A misdiagnosis of psychiatric problems is common. Because early symptoms may be mild, years may elapse between onset of the first signs and the diagnosis, which typically requires evidence of multiple neurologic attacks and characteristic remissions and exacerbations. Magnetic resonance imaging may detect MS lesions; however, diagnosis still remains difficult. Periodic testing and close observation of the patient are necessary, perhaps for years, depending on the course of the disease.
Abnormal EEG findings occur in one-third of patients. Lumbar puncture shows elevated gamma globulin fraction of immunoglobulin G but normal total cerebrospinal fluid (CSF) protein levels. Elevated CSF gamma globulin is significant only when serum gamma globulin levels are normal because it reflects hyperactivity of the immune system due to chronic demyelination. Oligoclonal bands of immunoglobulin can be detected when gamma globulin in CSF is examined by electrophoresis, and these bands are pres-ent in most patients, even when the percentage of gamma globulin in CSF is normal. In addition, the white blood cell count in CSF may rise. Differential diagnosis must rule out spinal cord compression, foramen magnum tumor (may mimic the exacerbations and remissions of MS), multiple small strokes, syphilis or other infection, and psychological disturbances.
Source: Professional Guide to Diseases (Eighth Edition), 2005
❑ Anxiety
❑ Depression
❑ Hypothyroidism
❑ Premenstrual syndrome
❑ Hypochondriasis
❑ Somatization disorder
❑ Chronic fatigue syndrome
❑ Fibromyalgia
❑ Panic disorder
❑ Malingering
❑ Conversion reaction
This presentation is marked by multiple vague complaints, symptoms out of proportion to the physical findings, symptoms outside the anticipated spectrum of the organic disease, and symptoms that do not follow anatomic distributions. The patient is often more concerned with the physician accepting authenticity of symptoms than relieving them. Vague, diffuse descriptions or overly detailed and elaborate symptoms are suggestive. The patient seems to be amplifying normal bodily sensations. Psychological factors may be revealed in the symbolic choice of words (e.g., “lump in the throat”).
“Stress” for most patients is an acceptable framework within which to obtain psychological information. Care must be taken during the interview not to suggest that the symptoms are “all in the head.”
A thorough and thoughtful history and physical examination are the basis for chosing specific diagnostic tests, and signal to the patient that the complaints are being taken seriously.
Source: Field Guide to Bedside Diagnosis, 2007
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