Ask the Doctor
Q: I was
recently diagnosed with MS and although I am not experiencing any symptoms
at this time, my doctor wants me to begin a drug therapy. Is early treatment
necessary even when no symptoms are present?
A: Treating MS early -- even when you are between attacks and having no symptoms -- will likely reduce your chances for future attacks and disability. We have learned that MS is still active in the brain even though a patient may have no symptoms. Our goal is to stop disease activity in the brain to reduce your chances of severe and progressive symptoms later in the course of the disease. I strongly encourage most of my patients to start drug therapy as soon as possible after the diagnosis.
Q: I have symptoms of MS, including increasing cognitive difficulties. Other probable diseases have been ruled out, while MS-like plaques and lesions were seen on my MRI. The results of my lumbar puncture (cerebrospinal fluid analysis), however, were inconclusive, showing no indication of MS. If this is the case, can a diagnosis of MS still be confirmed?
A: The diagnosis of multiple sclerosis usually depends on identifying MS-like symptoms coming from different parts of the brain and at different times. The neurologist’s examination and evaluation, along with an abnormal MRI, is often enough information to make an MS diagnosis if other illnesses have been ruled out. Abnormalities in the spinal fluid may not be present, even if someone has MS, and therefore, are not required for an MS diagnosis.
Q: I am in my 60’s and was clinically diagnosed with MS, despite the fact that an MRI showed no signs of the disease. What other tests would you suggest to rule out any other condition? (I was tested for Lupus with negative results.)
A: While the diagnosis of MS is not totally dependent on an abnormal MRI, more than 90 percent of people with MS have an abnormal MRI within three years of their first symptoms. Therefore, a normal MRI alerts me to look extensively for other causes of a person’s symptoms. Some of the other conditions I have diagnosed when MS is suspected include: Lupus, thyroid disease, AIDS, spinal column or skull abnormalities, tumors, strokes, and even psychological problems. Only your doctor will know which other possible diagnoses deserve further consideration based on your symptoms and examination.
Q: I was recently diagnosed with benign MS. Can you give me some information about this type of MS?
A: “Benign MS” is characterized by a few mild attacks, widely scattered over several years, with nearly complete recoveries. “Benign MS” does not lead to significant neurological problems during a person’s lifetime. Diagnosing “benign MS” is problematic because we cannot be absolutely certain of the diagnosis for 15 years or more. In other words, patients who look like they will have very mild MS can develop more symptoms after several years. “Benign MS” represents less than 10 percent of all MS cases. I am so concerned when I believe my patient has “benign MS,” that I order frequent MRIs, even for people without new symptoms. In reality, “benign MS” is usually a retrospective diagnosis confirmed after several years. If I diagnose “benign MS” and I am wrong, my patients have carried the risk of more damage to the brain by not starting treatment early.