Multiple Sclerosis Diagnosing

Posted by:Dr.Iliana

The underlying autoimmune process in MS causes demyelination of white matter in brain and spinal cord, resulting in episodes of variable focal neurological symptoms.

Remember the essence of modified McDonald’s Criteria used for MS diagnosis – dissemination in space (two or more focal neurological symptoms) and time (two or more episodes of symptoms) without a better neurological explanation.

Most common presenting symptoms of MS;

Motor symptom	lower extremities paraparesis with spasm, indicating UMNL aka upper motor neuron lesion (exception in patient with concomitant cerebellar involvement, which cause muscular hypotonia).
Sensory symptom	Hypoesthesia-numbness and paresthesia-tingling sensation
Optic nerve involvement	Decreased visual acuity-blurred vision and diplopia-doubling of vision, or optic neuritis- unilateral eye pain which increases with eyeball movement, often accompanied by decreased visual acuity
Cerebellar sign	Loss of balance (the pathognomonic scanning speech is seldom meet)

Apart from above stated common symptoms, most of MS patient also experienced nonspecific generalized symptoms such as;

Increased fatigability, typically in mid afternoon

Depression

Heat insensitivity, which is provoked or worsened when exposed to heat, e.g. a hot shower

NB – Patient with MS tend to neglect or forget their symptom (especially the presenting ones), as most of the them are temporary. Therefore it’s crucial to ask thoroughly about other common neurological symptoms. A simple question like “Have you ever experienced blurring of vision or unexplained weakness and numbness in your leg/hand before? ” would remind the patient about their previous symptoms .

When should we suspect MS?

(NB – MS is relatively rare in Malaysia and other South East Asian countries)

Onset of symptoms in patient aged 20-50 years old;

onset earlier than 20 years is more typical for hereditary diseases e.g. spinocerebellar atrophy, while in patient older than 50 years such symptom are more frequently caused by TIA aka transient ischemic attack, or reversible ischemia.

Symptoms and signs indicating the involvement of central nervous system

(i.e. any part of the brain or spinal cord);

Optic-spinal form of MS aka OSMS is more often encountered in South East Asian region than prototypic/classical MS which is typical in western countries

Two or more episodes lasting at least 24 hours and occurring at least one month apart;

usually symptom develops progressively during few days, stabilized than regress spontaneously or due to corticosteroid administration – NB – regression maybe complete or partial according to course of the disease, note that in primary progressive type there might be no regression of the symptom at all

Further Management

Refer patient to neurologist – this is the best part being a family med specialist - we diagnose and let others manage (kidding =p)