DIAGNOSIS:
The diagnosis of MS is meant to be a clinical one, backed up by laboratory tests. In practice, the MRI appears to be a standard of diagnostic practice, since it has become readily available for use. This article notes the relatively high rate of people misdiagnosed with MS, and notes the reason may be the reliance on MRI to make the diagnosis http://www.oregonlive.com/health/index.ssf/2012/05/insight_into_why_hundreds_of_p.html
Unfortunately MS symptomology is often readily apparent before it is suggested by laboratory tests, including MRI. Perhaps this is why so many people with MS complain of being told it is 'all in their heads' and are referred for psychological or even psychiatric assessment before they are eventually diagnosed?
A thorough and open minded doctor who will refer to a neurologist with excellent skills in medical history taking and examination, and with considerable clinical experience is therefore to be wished for.
The basic criteria for MS is that the clinical picture points to lesions in the brain and/or spinal cord which are separated in space (within the CNS) and by time. However, MS is also a diagnosis of exclusion, so the above criteria must be met, but anything else that looks like MS must also be ruled out too.
Mostly, these attacks will get better, in part, or almost completely, so the patient may feel themselves fully recovered, unless under some stress; emotional, physical (like exertion), environmental (such as heat or cold), or illness, by the time they see a neurologist.
A single attack may be noted as clinically isolated syndrome (CIS) or transverse myelitis if it is in the spinal cord, or some other non-committal term. It is thought that between remissions, the disease is still active. In this case, the diagnostic criteria essentially oblige a doctor to wait while suspected MS smoulders in the body, until at least two exacerbation/remission cycles have occurred. There must be very few serious diseases where a physician must wait until a disease is firmly entrenched before diagnosing or at least treating.
With exacerbation cycles often happening slowly (maybe once a year or less) or with symptoms clearing before a person can see a neurologist, and laboratory findings lagging behind signs and symptoms, it can be many months or many years before a diagnosis is obtained.
MS is known to be exacerbated by stress, but of course someone who is in diagnostic limbo land, faced with potentially terrifying and debilitating neurological symptoms, plus the psychological uncertainty and the need to keep functioning at peak performance to meet responsibilities while feeling very ill, can place the patient under the enormous stresses which they should be managing or avoiding to reduce stress-related relapse.
As noted earlier, MS is said to be a 'diagnosis of exclusion' because many other disease processes can mimic MS. Until those conditions are eliminated as suspects, MS cannot be confidently ruled in. Many of these are very curable or completely curable conditions if caught early, but can cause irreparable damage if ignored.
Therefore, if a wait-and-see posture is adopted in relation to further attacks, the person may consider having a timely and very focussed conversation with the doctor about differential diagnoses, and ask for clear advice about what the doctor is eliminating from the picture and why they are confident that they can safely do so. If the doctor doesn't mention an illness that is of specific concern to you, you may ask directly. Having the worry that you are not being properly examined while a disease process may be smouldering in your body is not a comfortable place to be.
There is no definitive test for MS. Even MRI is not definitive, since other diseases produce lesions that appear the same on MRI. This is why MRI is supportive of a clinical diagnosis. However, anecdotally, it seems possible that a doctor may still wait to see lesions on MRI before calling the diagnosis, and this again may take many months or years. Anecdotally, some doctors may not even treat a relapse with steroids unless they see new lesion activity on MRI.
Given the potential delays outlined above, a person with suspected MS may wish to embark on a wellness maximisation program without waiting for mainstream medicine to catch up.
In summary, a proactive patient, whilst waiting for a diagnosis may wish to note down all differential diagnoses and the grounds on which they were excluded, to request other differential diagnoses be examined and eliminated if the doctor is not considering them, or to ask why the doctor will not do so, and to take immediate steps to maximise their wellness, in multiple dimensions of their lives.
Please see 'exploring possibilities' for more information.
The diagnosis of MS is meant to be a clinical one, backed up by laboratory tests. In practice, the MRI appears to be a standard of diagnostic practice, since it has become readily available for use. This article notes the relatively high rate of people misdiagnosed with MS, and notes the reason may be the reliance on MRI to make the diagnosis http://www.oregonlive.com/health/index.ssf/2012/05/insight_into_why_hundreds_of_p.html
Unfortunately MS symptomology is often readily apparent before it is suggested by laboratory tests, including MRI. Perhaps this is why so many people with MS complain of being told it is 'all in their heads' and are referred for psychological or even psychiatric assessment before they are eventually diagnosed?
A thorough and open minded doctor who will refer to a neurologist with excellent skills in medical history taking and examination, and with considerable clinical experience is therefore to be wished for.
The basic criteria for MS is that the clinical picture points to lesions in the brain and/or spinal cord which are separated in space (within the CNS) and by time. However, MS is also a diagnosis of exclusion, so the above criteria must be met, but anything else that looks like MS must also be ruled out too.
Mostly, these attacks will get better, in part, or almost completely, so the patient may feel themselves fully recovered, unless under some stress; emotional, physical (like exertion), environmental (such as heat or cold), or illness, by the time they see a neurologist.
A single attack may be noted as clinically isolated syndrome (CIS) or transverse myelitis if it is in the spinal cord, or some other non-committal term. It is thought that between remissions, the disease is still active. In this case, the diagnostic criteria essentially oblige a doctor to wait while suspected MS smoulders in the body, until at least two exacerbation/remission cycles have occurred. There must be very few serious diseases where a physician must wait until a disease is firmly entrenched before diagnosing or at least treating.
With exacerbation cycles often happening slowly (maybe once a year or less) or with symptoms clearing before a person can see a neurologist, and laboratory findings lagging behind signs and symptoms, it can be many months or many years before a diagnosis is obtained.
MS is known to be exacerbated by stress, but of course someone who is in diagnostic limbo land, faced with potentially terrifying and debilitating neurological symptoms, plus the psychological uncertainty and the need to keep functioning at peak performance to meet responsibilities while feeling very ill, can place the patient under the enormous stresses which they should be managing or avoiding to reduce stress-related relapse.
As noted earlier, MS is said to be a 'diagnosis of exclusion' because many other disease processes can mimic MS. Until those conditions are eliminated as suspects, MS cannot be confidently ruled in. Many of these are very curable or completely curable conditions if caught early, but can cause irreparable damage if ignored.
Therefore, if a wait-and-see posture is adopted in relation to further attacks, the person may consider having a timely and very focussed conversation with the doctor about differential diagnoses, and ask for clear advice about what the doctor is eliminating from the picture and why they are confident that they can safely do so. If the doctor doesn't mention an illness that is of specific concern to you, you may ask directly. Having the worry that you are not being properly examined while a disease process may be smouldering in your body is not a comfortable place to be.
There is no definitive test for MS. Even MRI is not definitive, since other diseases produce lesions that appear the same on MRI. This is why MRI is supportive of a clinical diagnosis. However, anecdotally, it seems possible that a doctor may still wait to see lesions on MRI before calling the diagnosis, and this again may take many months or years. Anecdotally, some doctors may not even treat a relapse with steroids unless they see new lesion activity on MRI.
Given the potential delays outlined above, a person with suspected MS may wish to embark on a wellness maximisation program without waiting for mainstream medicine to catch up.
In summary, a proactive patient, whilst waiting for a diagnosis may wish to note down all differential diagnoses and the grounds on which they were excluded, to request other differential diagnoses be examined and eliminated if the doctor is not considering them, or to ask why the doctor will not do so, and to take immediate steps to maximise their wellness, in multiple dimensions of their lives.
Please see 'exploring possibilities' for more information.