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My Family Doctor says that I may have MS...what do I do now???
Ok, so you have been to see your pcp (USA) or g.p. (Canada) and they think that your symptoms are pointing towards something Neurological...possibly Multiple Sclerosis. They tell you that you are going to have to have an MRI (Magnetic Resonance Imaging) and you will be referred to a Neurologist.
STOP! You have to tell your doctor that if there is a possibility that you may have MS you need to see an MS Specialist rather than a Neurologist!
Why, you ask? While a neurologist can deal with many neurological diseases, if you are suspected of having MS you NEED to be treated by an MS Specialist.
An MS Specialist is trained to study your MRI and has the experience to discern differences in your MRI that a Neurologist or Radiologist doesn’t have. This ensures that you will have the proper results at the start of what could be a long journey to a diagnosis.
When you go to see your MS Specialist, the first thing that he/she will want is a full history. It would be helpful to you both, the patient and the doctor, if you were to make up a timeline of your symptoms ahead of time. This will give the doctor a better picture of your symptoms and will take the pressure off of you to remember everything in a stressful situation.
The next thing the MS Specialist will do is a full in-office Neurological Exam. It is imperative that this exam is done and if it is not done it is up to you to be pro-active and INSIST that this exam is performed.
This is a head to toe exam that may include requests for you to walk across the floor heel to toe, you will be asked to touch your finger to the doctors' finger which is suspended in front of you and then to your nose with your eyes closed, you will be asked to rub your heel down your opposite shin...nothing too scary, they just seem a little strange. A good exam will probably take 30 minutes or more. The results of this examination will tell your MS Specialist about your Mental Status, Cranial Nerves, Motor Skills, Coordination and Gait, Reflexes and Senses. This in- office examination is crucial to the possibility of a diagnosis of MS.
If you haven't already, the MS Specialist will send you for an MRI. This is an imaging tool that uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of your brain. These images can then be examined on a computer monitor. The MRI does not use ionizing radiation.
Ok, so now you have had an MRI and an in-office examination and the results are inconclusive...What next?
Your MS Specialist may suggest a Lumbar Puncture. It sounds scarier than it is and most people have no difficulty with it at all.
During the Lumbar Puncture the MS Specialist or Radiologist will extract a small amount of spinal fluid from your lower back and it will be studied for the presence of Oligoclonal Banding which is present with MS. If there are no Oligoclonal Banding a positive IgG index will suffice as a positive LP. The fluid will also be studied for a myriad of other diseases as well.
If MS is highly suspected but there is not enough evidence for a diagnosis then Evoked Potential Testing is brought into play. Evoked Potential testing measures the time it takes for a nerve to respond to stimulation. There are three types of tests used to obtain evoked potentials, Visual evoked, Auditory brain stem evoked and Somatosensory. Each response is recorded from brain waves by using electrodes taped to the head. Visually evoked response is the most commonly used to diagnose MS.
The preceding are the tests that are used to try to discern whether a diagnosis of MS can be made or not. It is very important to remember that a good MS Specialist that suspects MS but can find no evidence, follow up with the patient at 3 to 6 month intervals, for years, if necessary, to gain further information.