Potential Improvements in Diagnosing Multiple Sclerosis
Some diseases are relatively easy to diagnose because there are accurate tests and clear signs and symptoms. But when it comes to diagnosing multiple sclerosis (MS), doctors and patients face a significant challenge because the signposts are not clear. Here is the latest news on how healthcare providers may someday soon approach the diagnosis of MS using some potential improvements.
MS in a nutshell
Multiple sclerosis is an autoimmune disease characterized by damage or destruction of the protective coverings (myelin sheaths) on nerve cells. This damage can cause mild to severe disabilities ranging from loss of muscle strength to fatigue, bladder and bowel dysfunction, vision problems, dizziness, pain, loss of balance, and emotional disorders, among others.
Although there are several types of MS, the form that affects most people with the disease is relapsing-remitting MS. This form typically develops when individuals are in their 20s or 30s and is characterized by periods when symptoms flare up followed by times when symptoms decline or even disappear only to return again at a later time.
Potentially new ways to diagnose MS
At the University of Western Ontario (Canada), two researchers used one of the recommended ways to help diagnosis MS—magnetic resonance imaging (MRI; see below)—to look for iron deposits located in deep gray matter in the brains of 22 individuals with clinically isolated syndrome (CIS) and 16 controls. Iron deposits are commonly see in MS patients, but experts are uncertain whether they are a cause or effect of the disease.
CIS is the result of a single episode of damage to the myelin in one or more areas of the central nervous system that lasts for 24 hours or longer. Among people who are diagnosed with MS, 85 percent experienced CIS.
In the new study, the investigators found that
- Iron accumulations in the brain were significantly greater among individuals with CIS than among control
- The white matter in the brains of CIS patients showed mild damage, even at this early stage
The researchers plan to continue evaluating the study participants for two years with the hope that this imaging approach will result in an earlier diagnosis of MS. Earlier diagnosis can mean more timely treatment and lifestyle changes.
Several years ago, a research team at UT Southwestern Medical Center found that an eye test called optical coherence tomography (OCT), which measures thinning of the retina in people with MS, has the potential to help with the diagnosis of MS. Further work in this area may result in ophthalmologists being able to use OCT to identify possible MS.
Current ways to diagnose MS
Typically, physicians have followed a process of searching for evidence of central nervous system damage and elimination of other possible diseases when determining whether a person’s signs and symptoms may be MS. Clinicians have guidelines, established by the International Panel on the Diagnosis of Multiple Sclerosis, to help make a diagnosis.
In addition to taking an extensive patient history and conducting neurological testing, the criteria for diagnosis include:
- Analysis of the cerebrospinal fluid to identify the amount of certain proteins and oligoclonal bands, which are seen in 90 to 95 percent of people who have MS. However, oligoclonal bands are not exclusive to MS so other tests are necessary as well to make a definitive diagnosis.
- Use of magnetic resonance imaging (MRI), which can identify MS scarring or lesions in various parts of the central nervous system
- Visual evoked potentials, which are tests that record the nervous system’s electrical response to stimulation.
Doctors may order blood tests to help rule out other diseases.
The diagnosis of MS remains a challenge, yet researchers are exploring more efficient ways to identify the disease and at an earlier stage of its development.
SOURCE: University of Western Ontario