Exams, Tests and Procedures

SOURCE: www.Mult-Sclerosis.org, www.NLM.NIH.gov/MedlinePlus

and MY FRIENDS at Patients Like Me and MYSELF!

A history of at least two attacks separated by a period of reduced or no symptoms may be a sign of relapsing-remitting MS.

There are many different neurological tests and the ones your neurologist chooses to perform will depend, in part, on the symptoms that you present with. Here are some of the more common ones.

Symptoms of MS may mimic many other neurologic disorders. Diagnosis is made by ruling out other conditions.

If the health care provider can see decreases in any functions of the central nervous system (such as abnormal reflexes), a diagnosis of MS may be suspected.

A neurological exam may show localized decreases in nerve function. This may include decreased or abnormal sensation, decreased ability to move a part of the body, speech or vision changes, or other loss of neurologic functions. The type of neurologic deficit, which is a decrease in the function of the brain, spinal cord, muscles, or nerves, indicates the location of the damage to the nerves.

There may be a positive Babinski's Sign.

Eye examination may show abnormal pupil responses, changes in the visual fields or eye movements, rapid eye movements triggered by movement of the eye, decreased visual acuity, or problems with the internal structures of the eye.

Tests that indicate or confirm multiple sclerosis include:

	Romberg's sign: This is a test for ataxia (incoordination or clumsiness of movement that is not the result of muscular weakness) and involves standing with your feet together with your eyes closed. Ataxics have great problems standing still under these conditions.
	Gait and Coordination: The neurologist evaluates ataxia in various parts of the body by observing the patient walking normally, walking heel-to-toe and finger-to-nose tests. The neurologist will also be looking for intention tremor (shaking when performing small motor movements) as well as ataxia in this last test.
	Heel/Shin test: This is a test for ataxia and cerebellar dysfunction. You have to bring the ball of your heel onto the knee of your other leg and then move it down the shin.
	L'Hermittes sign: This is a test for lesions on the spinal cord in the neck. The neurologist will ask you to lower your head towards your chest. A positive L'Hermittes will generate buzzing, tingling or electrical shock sensations in one or more parts of the body.
	Optic Neuritis: This is a condition of the eye caused by inflammation and demyelination of the Optic Nerve and is perhaps the most commonly presenting symptom in MS. The tests involve the ubiquitous reading of letters from a board and a test for colour vision using an "Ishihara" colour chart. An examination with an opthalmoscope will reveal pallor of the optic nerve in old optic neurites.
	Hearing Loss: This is done by lightly clicking the fingers next to each ear and asking the patient which ear the click was done next to.
	Muscle Strength: This involves resisting the neurologist with various muscle groups. Differences in strength between left and right sides are easier to evaluate than symmetrical loss unless the weakness is severe.
	Reflexes: This is done with both ends of the hammer. The reflexes can be normal, brisk, i.e. too easily evoked, or non-existent.
	Chaddock's Sign: Similar to Babinsky's but testing for lesions in the corticospinal tract. The neurologist touches the skin at the outside of the ankle. A positive response in upwards fanning of the big toe just like in Babinski's test.
	Hoffman's sign: This is also similar to Babinski's but involves the hands rather than the feet. Again it tests for problems in the corticospinal tract. The test involves tapping the nail on the third or forth finger. A positive response is seen in flexion of terminal phalanx of thumb.
	Doll's Eye Sign: The neurologist is looking for dissociation between movement of the eyes and of the head. A positive response is when the eyes moves up and head moves down.
	Sensory:  This is done with tuning forks and pins and tests the level of sensory perception in certain parts of your body.
	MRI of the Head
	Spine MRI
	Lumbar puncture (spinal tap) for collection of Cerebrospinal fluid
	CSF (Cerebrospinal fluid tests), including CSF oligoclonal banding
	A neurological exam
	VEP (Visual Evoked Potential) - VEP are similar to somatosensory potentials; however, the stimulation is applied as patterns or flashes of light seen by the eye, and the brain's response to the visual stimulus is then assessed with EEG electrodes.  The VEP will  detect loss of vision from optic nerve damage (in particular, damage caused by multiple sclerosis). The patient sits close to a screen and is asked to focus on the center of a shifting checkerboard pattern. Only one eye is tested at a time; the other eye is either kept closed or covered with a patch. Each eye is usually tested twice. Testing takes 30-45 minutes.
	SEP (Sensory Evoked Potential) - SEP use EEG electrodes to record the response of the brain to a sensory stimulus. Usually a small electrical pulse is given at the wrist or behind the knee. The response in the EEG is then measured. The pulse needs to be repeated at least several hundred times in order to have enough of a signal to analyze. From this information, the evaluator may determine whether there is a delay in conduction to the brain, a blockage at any point, or abnormally low or high activity in the brain.
	BAER ( Brainstem Auditory Evoked Response)

The items below have been added by my friends at Patients Like Me and me.

Even before you are diagnosed you will go through more things among them are many neurological exams, blood work a neuro exam every 2-3 months (more in the beginning), urine and stool samples and an eye exam.

There might be more done depending on your situation.

If your spasticity is excessive bad your doctor might suggest a  Intrathecal Baclofen Pump.  Here is some information on the pump.