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Testing, Testing, 1-2-3...

© Pamela Martin

Those of us who have already undergone the diagnostic phase of multiple sclerosis know that laboratory tests are helpful, but are also limited and fallible. Because no one test can confirm multiple sclerosis with 100% certainty, the testing process can be particularly frustrating.

Many patients are left in a "diagnostic-limbo" when they are told by their doctors that they have possible MS. This uncertainty can occur when test results are normal even though the patient's symptoms are very real. These patients remain in a holding pattern as time elapses, waiting to see if their symptoms will end, or if repeat tests and new symptoms are more indicative of MS. Over time, the diagnosis may be modified to probable MS if the patient meets the diagnostic criteria.

Although laboratory tests and scans are limited in their power to diagnose multiple sclerosis outright, they can strongly suggest MS, and are invaluable in helping to rule out other conditions that have similar symptoms.

The three tests typically used during the diagnostic process for multiple sclerosis are:

1. the MRI;
2. the lumbar puncture (spinal tap); and
3. the evoked potential.

Each of the tests concentrates on a separate piece of the diagnostic puzzle. Theoretically, when the test results are merged together, it provides the physician with a total picture that either suggests or dismisses a diagnosis of MS.

1. Magnetic Resonance Imaging (MRI)

What happens during the procedure?

For an MRI, the patient disrobes and puts on the standard hospital gown. Prior to the scan, any metallic objects (such as jewelry, hearing aids, zippers, pins, etc.) are removed so as not to distort the scans.

Next, the patient lies down on a narrow table that slides into the tunnel-shaped scanner. People who are bothered by feelings of claustrophobia when enclosed in small places can request a mild sedative beforehand. A pillow or blanket is generally available for those who are sensitive to cold or who find the table uncomfortably hard. The technician can usually provide a foam support to put under the knees of patients who have lower back trouble and find it difficult to lie flat on the back.

It's important to be comfortable so that you can lie still, because excessive movement creates blurry images. During my last MRI, I was given headphones and a choice of calming music to listen to (I chose Vivaldi).

Essentially, the MRI scanner creates a magnetic field around the body and then emits radio wave pulses, which produce loud thumping noises. The MRI is considered a painless procedure because neither the magnetic field nor the radio waves are felt. The technologist observes the procedure and can communicate with the patient through the headphones or an intercom system. Each set of MRI images can take from a few to several minutes to complete. In general, MRI imaging takes around an hour.

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