How Is Multiple Sclerosis (MS) Diagnosed?
Medically reviewed by Nicholas R. Metrus, MD
A neurologist (who specializes in nerve conditions) can usually diagnose multiple sclerosis (MS) with a neurological exam. They'll start by asking about your medical history and test your brain-related functions, like your motor skills and eyesight. The neurologist will use brain imaging, blood tests, and other procedures to confirm a diagnosis.
MS is a condition of the central nervous system, which includes the brain and spinal cord. MS develops when your immune system attacks the protective myelin sheath that protects your nerve cells. The disease affects the whole nervous system, so symptoms can be unpredictable and varied. Most cases of MS are mild, but you can develop impaired vision, movement, memory, and more.
MS usually develops in people aged 20–40. The most common type of MS is relapsing-remitting MS (RRMS): Symptoms flare during a relapse period, which is then followed by a remission period, or when there are reduced or no symptoms.
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Related: How is Migraine Diagnosed?
Medical History
Discussing your symptoms and medical history with a healthcare provider is the first step toward an MS diagnosis. Common MS symptoms include:
Constipation, diarrhea, or incontinence (trouble holding your urine)
Depression or anxiety
Difficulty speaking or swallowing
Having imbalance when walking or vertigo (the feeling that you and your direct environment are spinning)
Memory issues or trouble concentrating
Numbness, feeling "pins and needles," or abnormal burning and tingling in the skin
Seeing double (double vision), eye pain, vision loss, or swelling of the optic nerve (which connects your brain to your eye)
Weakness, shaking, or fatigue
You don't have to experience all types of symptoms at once to have MS. You may not experience symptoms at all if you're in remission.
What causes MS is unknown. Experts suspect the disease may result from genetics, environmental factors, and factors within your immune system. A healthcare provider will also ask about your family history, living environment, other health conditions, and the places you've traveled. It's important to share as much of your personal history as you can.
Physical and Neurological Exam
A healthcare provider will perform a neurological exam to test how well your brain and spinal cord are working. They may use different tools to examine the following:
Genitals: A healthcare provider may teach you how to do a nocturnal penile tumescence stamp test if you have a penis. This test can determine if you have erectile dysfunction.
Hearing: This can include using a tuning fork to test whether you have hearing loss.
Kidneys and urinary tract: Lab tests based on blood and urine samples can check kidney function. A healthcare provider might use an ultrasound or a catheter (a thin tube inserted into the urethra) to see if you have urinary retention, which is leftover urine in your bladder after peeing.
Mental health: A healthcare provider provider can ask about your recent mood and behaviors to figure out if you have depression or anxiety.
Muscles and nerves: A healthcare provider may use a reflex hammer to check your muscle response and body coordination. They can check your ability to swallow or if you have signs of shaking, weakness, muscle spasms, and overactive reflexes.
Vision: This may involve a flashlight or other eye tool to check for uncontrolled movements, double vision, and pain in your eyes. A healthcare provider can also test for pupil asymmetry (anisocoria) and visual acuity and color saturation.
Types of MS
A healthcare provider can determine what type of MS you have, depending on how often you have symptoms. There are four main types of MS, including:
Clinically isolated syndrome (CIS): This is the first MS attack. You have never had any previous MS symptoms of MS and do not have a fever or infection. Symptoms can happen suddenly, flaring for at least 24 hours and lasting a few days or weeks.
Primary progressive MS (PPMS): This causes gradual worsening of symptoms over time since developing MS. There are no relapses or remission periods with this type.
Relapsing-remitting MS (RRMS): This is the most common type of MS. Symptoms can flare up within 24–48 hours and develop over several days to weeks. You can usually recover from symptoms after several weeks or months, with or without medication. You'll then enter remission, or a period of little to no symptoms.
Secondary progressive MS (SPMS): This type causes gradually worsening symptoms, with anything from relapses or MRI changes to minor remissions and plateaus. If relapses or MRI changes occur, you have "active" SPMS. If there are no changes, you have "inactive" SPMS.
Additional Tests To Confirm an MS Diagnosis
A healthcare provider or neurologist may refer you to other specialists. The following tests can help confirm an MS diagnosis and exclude other conditions with similar symptoms.
Magnetic Resonance Imaging (MRI)
A magnetic resonance imaging (MRI) test is a non-invasive procedure that uses radio waves and a magnetic field to capture images of the body. This method does not use radiation.
A radiologist can take an MRI of your brain and spinal cord to determine the severity, shape, and location of nerve damage. They can use MRIs to see if you have MS or another condition, as well as to track your condition in the long term. An MRI, for example, can detect new areas of nerve damage.
Cerebrospinal Fluid Analysis
The brain and spinal cord tissues have a protective layer of cerebrospinal fluid (CSF). A healthcare provider can remove a small amount of CSF using a CSF analysis. They'll examine the sample for signs of neurological diseases.
CSF analysis is especially useful for diagnosing early stages or rare forms of MS. This test can also help rule out other nervous system conditions and viral infections. Keep in mind that there's no diagnostic marker that's specific to MS in CSF. There are only markers that can suggest MS, but other tests confirm a diagnosis.
The procedure to collect CSF is a spinal tap (lumbar puncture). You'll get a local anesthetic injection in your back to numb any pain. A healthcare provider will then use a special needle to take some fluid (about 3 teaspoons) from your spinal sac.
Blood Tests
A healthcare provider can use blood tests to rule out other conditions that cause similar symptoms. These blood tests may measure:
Cholesterol
Electrolytes
Vitamins D and B12
A healthcare provider can use these measurements to analyze your liver and kidney function. They may also check for inflammation and immune system activity.
Brain Signal Tests
A neurologist can use an evoked response test (evoked potentials) to monitor your brain signals as you hear, touch, and see. They'll apply a special paste to your scalp and attach electrodes connected to a machine.
This test can help determine if you have MS. Signals sent through the nerve cells travel at a slower speed in people with MS.
Screening for Related Conditions
MS symptoms vary widely, so it's essential to rule out similar diseases. Related conditions include lupus, neuromyelitis optica (NMO) spectrum disorders, acute disseminated encephalomyelitis (ADEM), and Sjögren's syndrome. These conditions can affect your central nervous system.
A healthcare provider may order tests for specific conditions, including:
Biopsy (a procedure that removes cells or tissue from your body to check for damage or disease)
Cognitive testing
Hearing tests
Heart tests, such as an echocardiogram (echo)
Optical coherence tomography (a non-invasive imaging test for your retina) or other eye exam
Tests for specific infections, such as Lyme disease, syphilis, or human immunodeficiency virus (HIV)
Urodynamic testing (study of your bladder and urethra function)
X-ray imaging
A healthcare provider or neurologist will consider certain features of your disease to determine what additional tests, if any, are necessary. They may consider your family history of neurological diseases other than MS and symptoms like headaches, weight loss, and fever. They'll also get a detailed picture of the timing and seriousness of your symptoms.
Related: How Is Parkinson’s Disease Diagnosed?
A Quick Review
A timely diagnosis of multiple sclerosis (MS) can help you get the right treatment earlier. Be prepared to talk to a healthcare provider or neurologist about your medical history. They may determine whether you have MS based on your symptoms and a neurological exam. MRIs, blood tests, and cerebrospinal fluid analyses are commonly used as diagnostic tools.
A healthcare provider may also rule out other similar conditions that can affect your central nervous system, such as lupus and Sjögren's syndrome.
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