MULTIPLE SCLEROSIS 
BRIDGE THE GAP TO YOUR DIAGNOSIS AND MANAGEMENT 

MS is defined as two or more presentations with a typical neurological constellation of symptoms and signs. The diagnosis may be supported by other criteria such as the changes on a brain scan, lumbar puncture and blood tests. There are many symptoms present in MS that are not unique to it and more frequently present with other disorders or no specific diagnosis, such as fatigue or depression. So investigation may be useful to exclude it as a possible diagnosis to focus on treating other diagnoses. 

The patient with MS will have have a first presentation, sometimes not diagnosed or dismissed as a “viral syndrome”. A neurologist will know what are the types of typical MS presenting features such as optic neuritis, transverse myelitis, cerebellar syndromes, or internuclear ophthalmoplegia. 

Not everyone who has an MS-like presentation the first time will get MS, and therefore this first presentation is called a Clinically Isolated Syndrome (CIS). The CIS may be any of the types of MS features listed above. Investigation after a CIS may help to determine risk of it becoming MS in the future.

After any CIS or MS relapse, treatment with steroids (intravenous or oral) can speed up recovery. Steroids are given for 3 to 5 days only, and usually reserved for presentations that involve more than just a sensory change (i.e. not just pins and needles/numbness)

There are several disorders that mimic MS, and are important to consider in the diagnostic stages.

Sensory changes in isolation are usually not MS or a CIS. Your neurologist will be able to expertly assess the whole presentation and put things together, which may ultimately be “no cause for symptoms identifiable.” 

This is a common scenario and represents between 12-30% of what a neurologist sees overall. Sensory symptoms in isolation are often benign, and long-term follow-up studies on this group has shown that a tiny minority of patients end up with a disease, which is reassuring to us that it is rare to miss a diagnosis. It may not be necessary to do any investigation, and your neurologist will advise you on this. Routine blood testing of thyroid function, renal function, full blood count, bone profile, vitamin B12, inflammatory markers (ESR, C-reactive protein), HIV and syphilis is often done to rule out treatable causes of symptoms. 

For more information on CIS and MS, please look at: