investigations

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Investigation in multiple sclerosis include:

  • MRI scanning:
    • permits the visualisation of the dissemination of lesions in time and space
    • will reliably identify plaques in the cortex, brainstem and spinal cord
    • gadolinium enhancement improves sensitivity

  • CSF:
    • permits the detection of intrathecal inflammation
    • pleocytosis
    • slightly raised protein
    • 70% of patients hace a raised IgG - electrophoresis reveals oligoclonal bands in the CSF which are not found on serum electrophoresis

  • visual evoked potentials:
    • permit the demonstration of conduction changes consistent with demyelination
    • are of normal amplitude but show an increased latency in patients who have or have had optic neuritis
    • measurement of visual evoked potentials is a good way of demonstrating a previous, often subclinical, episode of demyelination in order to make the diagnosis of multiple sclerosis
    • auditory brainstem evoked potentials and somatosensory evoked potentials may also be measured

Before referring a person suspected of having MS to a neurologist, exclude alternative diagnoses by performing blood tests including (1):

  • full blood count
  • inflammatory markers for example erythrocyte sedimentation rate, C-reactive protein
  • liver function tests
  • renal function tests
  • calcium
  • glucose
  • thyroid function tests
  • vitamin B12
  • HIV serology

Do not diagnose MS on the basis of MRI findings alone (1).

Reference:

Last edited 11/2019

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