What are the tests that suggest MS?

Question

Hello doctor,

I just completed my first round of evoked potential testing for MS diagnosis. The results show delayed conduction in both visual and sensory pathways, but my brain MRI is relatively normal. They found some lesions in my spine, though. My symptoms keep getting worse while we wait for a clear diagnosis. Do these test results suggest MS?

Please suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

A normal brain MRI (magnetic resonance imaging) does not rule out the possibility of MS (multiple sclerosis) as five percent of patients in the early course of the disease could have a normal brain MRI. We should not hesitate to diagnose MS in a patient with a good-quality brain MRI. The accuracy of MRI is questionable.

Visual impairment:

The conduction along the optic nerve is often slowed in MS.
Vision disorders are the first signs of MS in many people. Vision disorders are in the form of optic neuritis, diplopia (double vision), and nystagmus. These disorders develop because the nerve cells that control the function of the eye in the brainstem or cerebellum are not functioning properly. Patients have blurred, shimmering, or wavy vision.
Optic neuritis presents as a monocular sometimes painful visual loss that occurs over hours to days and lasts for a few weeks.
Visual problems are diagnosed clinically by MRI, CSF (cerebrospinal fluid) measurements and visual evoked potential studies.
Treated by IV (intravenous) Methylprednisolone 500 milligrams/day for five days, 250 milligrams/day for two days followed by oral corticosteroids. Baclofen and some anticonvulsants are effective.
The prognosis for recovery is good with treatment.

Sensory problems:

Many people with MS experience a change in feelings in their skin known as sensory symptoms or altered sensations that include feelings of pins and needles, burning, itching, electric zaps, shocks, numbness, pricking, and increased sensitivity.
These problems occur when nerve fibers carrying signals to muscles become demyelinated.
Spinal lesions are also related to demyelinated nerve fibers.

The probable causes are visual and sensory impairment in MS.

Diagnostic tests for MS:

Elevated IgG index.
Oligoclonal bands.
Anti aquaporin 4.
Antinuclear antibodies.
Anti-MOG antibodies.
Ig kappa free light chains.

Differential diagnosis:

Infectious disease and CMV (cytomegalovirus).
Herpes simplex.
Toxic neuropathy.

Probable diagnosis: Multiple sclerosis.

Treatment plan: IV Methylprednisolone.

I hope this has helped you.

Please feel free to reach me again, in case of further queries.

Thank you.