UNIVERSITY OF MARYLAND MEDICAL CENTER: CLICK TO READ MORE"In 2001 an international panel of experts recommended criteria, called the McDonald criteria, for diagnosing multiple sclerosis in early stages. They use the presence of specific symptoms, spinal fluid evaluation, and advances in magnetic resonance imaging for detecting lesions within the central nervous system and tracking them over time. The criteria are showing high reliability in identifying MS in patients with a variety of disease stages or states, including having only one episode (known as a clinically isolated syndrome), having a typical relapsing-remitting course, or having a slow insidious progression without clear attacks or remissions. Depending on the MRI and other findings, the patient is then categorized as having MS, possible MS, or no MS.

Ruling Out Other Disorders

The symptoms of MS are similar to a number of other diseases, which must be ruled out. These include stroke, alcoholism, emotional disorders, Lyme disease, chronic fatigue syndrome, fibromyalgia, AIDS, and certain other autoimmune disorders (e.g., scleroderma, Sjögren's syndrome, and systemic lupus erythematosus).

Expanded Disability Status Scale

Presently physicians and investigators generally use a test called the Expanded Disability Status Scale (EDSS) to rate the severity of symptoms. It is also used after a diagnosis to gauge status of the disease, and score the effectiveness of treatments. The scale ranges from zero to ten with higher scores indicating more severe symptoms. These are subjective ratings that require physician observation skills. [See Box Multiple Sclerosis Disability Score and Disease Progression.]

Objections to the use of the EDSS are that it assesses only limp and walking problems and does not assess other important complications, including fatigue, sexual function, and mental function.

Laboratory Tests

No reliable single laboratory procedure or test can establish the diagnosis of multiple sclerosis. Several are necessary before a diagnosis can be made.

Analysis of Cerebrospinal Fluid (CFS). Obtaining a sample of spinal fluid requires a lumbar puncture, or spinal tap. Testing spinal fluid is becoming increasingly important for detecting abnormal proteins, tiny fragments of myelin, or specific white blood cells that can help in making a diagnosis. For example, high levels of the immunoglobulin IgG is useful for making a diagnosis and may be a marker for disease progression. (Immunoglobulins are protein chains that are part of the immune system.)


A lumbar puncture, or spinal tap, is a procedure to collect cerebrospinal fluid to check for the presence of disease or injury. A spinal needle is inserted, usually between the 3rd and 4th lumbar vertebrae in the lower spine. Once the needle is properly positioned in the subarachnoid space (the space between the spinal cord and its covering, the meninges), pressures can be measured and fluid can be collected for testing.


Evoked Potential (EP) Test. This is a simple and painless electrical test of nerve function that assesses how long it takes nerve impulses from the eye, ear, or skin to reach the brain.

Investigative Laboratory Tests. A urine test that can show elevated levels of a substance called myelin basic protein-like material may become a convenient, economical, noninvasive way to monitor the progression of MS. This substance becomes elevated as axonal damage occurs when the disease progresses. Certain tests for color blindness may be helpful in tracking the effect of MS on the eyes.

Click the icon to see an image of urine testing.


Click the icon to see an example of the color blindness tests.


Magnetic Resonance Imaging

Magnetic resonance imaging scans are important diagnostic tools in MS and are used for diagnosing multiple sclerosis, tracking changes over time, and helping to determine treatment effectiveness.

Click the icon to see an image of a brain MRI.


Making a Diagnosis. Magnetic resonance imaging (MRI) scans can detect patches of injured tissue (lesions) that suggest MS. (It should be noted that such lesion scans may also indicate other conditions such as infections, migraines, or clots.) A very sensitive MRI technique using enhancement by an agent called gadolinium can detect disturbances in the blood-brain barrier that may indicate an early development of lesions. To make a complete diagnosis, an experienced physician, most often a neurologist, still needs to be familiar with the symptoms of multiple sclerosis.

Detecting New or Increasing Lesions. Once diagnosed, periodic follow-up MRIs can be used to track the disease and effectiveness of treatments in two ways:

By distinguishing new lesions from old ones.
Revealing increasing or decreasing numbers of lesions within the central nervous system over time.
Detecting lesions before further symptoms appear may allow a physician to initiate early treatment that may prove beneficial. Many experts therefore now advocate performing a brain MRI as soon as symptoms appear. However, neither the rate nor the number of new or growing lesions necessarily predicts immediate onset or worsening of symptoms or the development of secondary progressive MS.

Measuring Atrophy in Brain and Spinal Cord. As myelin, axons, oligodendrocytes, and neurons are destroyed, the brain begins to shrink. Processing MRI images to determine brain volume may be a useful way to monitor progression and treatment effects. MRI can also detect shrinkage in the spinal cord, which is proving to be a very strong marker of disease progression.

Detecting Black Holes. Severe disease progression can be gauged by the presence of so-called "black holes." These are lesions in the brain that emit very low signals on an MRI scan. Some evidence suggests that they may represent iron deposits in the brain."