Diagnosing multiple sclerosis: Recognizing symptoms and diagnostic testing

Approximately 2300 people in the UK are diagnosed with multiple sclerosis (MS) each year. There is no definitive test for MS and the diagnosis is based on evidence of dissemination in time and space of inflammatory episodes within the central nervous system in the absence of any better explanation. There have been many attempts in recent years to establish diagnostic criteria to ensure consistency of approach to diagnosis (particularly important when reviewing treatment options and for the purposes of research). These have evolved to include changes in practice and new evidence such as MRI scanning. The criteria currently in use are the revised McDonald criteria, which are predominantly based on MRI scanning. These are explained in a little more detail as are the relevant paraclinical tests. The importance of the recommendations made in the National Institute for Health and Clinical Excellence clinical guidelines for the management of MS regarding best practice when making and giving a diagnosis are also discussed.