Multiple sclerosis remains a clinical diagnosis that is based on the historical narrative that the patient gives as well as additional studies which include biochemical studies of the spinal fluid, MRI or imaging studies. They form the backbone on which a clinical diagnosis is made today.


Excerpted from the interview with Dr. Subramanian Sriram, Director of the MS Center at Vanderbilt University Medical Center

Multiple sclerosis remains a clinical diagnosis that is based on the historical narrative that the patient gives and also additional studies which include biochemical studies of the spinal fluid, and more recently for the last 20 years, MRI or imaging studies. They form the backbone on which a clinical diagnosis is made today.

Time to Diagnosis

The suspicion can take a fair amount of time. The history and the exam would point us in one direction, then we may have to order a spinal fluid analysis, which will take at least a couple of weeks for the spinal fluid results test to come back. Imaging studies, like the brain MRI and the spinal cord MRI, that can be rather quick and can do it in one to two weeks. Essentially, there will be a gap, sometimes three to four weeks, before a diagnosis is confirmed. When I say confirmed it means that the physician feels that this is the most likely explanation for the patient’s symptoms and complaints.

There is sometimes a long gap. Neurologists, especially those who specialize in MS, have a long backlog of new patients to be seen. It’s not uncommon for patients to wait a couple of months before they can be seen in our clinic to either confirm or exclude the diagnosis of MS. Yes, that is a long time between a primary care physician or someone in the community is suspecting it is MS, and it is either confirmed or refuted by the clinician.

A New Diagnostic Tool

From a community physician standpoint, either internist or even a community practicing neurologist, any test that will enhance their suspicion of MS has a large bearing on how they’re going to follow up on this patient, follow up with the studies. A blood test is of enormous importance to giving some degree of confidence, one way or the other, for the physician to proceed with either additional diagnostic studies or a referral to a specialist. It has a lot of strength in providing some basis for the suspicion. It is of enormous importance. We’ve been struggling to get a good blood test for MS for years. This is perhaps the first entrĂ©e into a diagnostic test using blood.

There are situations in which you are not sure of the diagnosis. The MRI may be non-specific and not very supportive. The spinal fluid studies may be borderline, not be diagnostic. Having a test that refutes the diagnosis of MS because the test is negative gives you some degree of confidence. Let’s look at other avenues that may be going in the patient’s nervous system, giving rise to the patient’s complaint.

One of the first lines of investigative modalities would be the blood test, let’s exclude other things, and then we can order an MRI. Then we will see if we need a spinal tap. What I foresee is that this blood test will be incorporated into the diagnostic criteria, and the diagnostic test that will confirm to a high degree of certainty that this person has MS.