Understanding Multiple Sclerosis (MS): A Leading Neurologist Explains Symptoms & Diagnosis

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Diagnosing Multiple Sclerosis (MS): The Basics

Multiple sclerosis (MS) is an “immune mediated condition,” which causes the immune system to work against itself, Dr. Lauren Krupp, a neurologist at NYU Langone in New York City, tells SurvivorNet.
It can affect different areas of the central nervous system, or brain and spinal cord, and the location can impact which symptoms someone experiences.
Symptoms might include numbness and tingling in the face, numbness/weakness in the arms and legs, vertigo, vision loss or blurred vision, or lack of coordination.
A brain MRI is a key tool when it comes to diagnosing MS. MRIs detect lesions found on the brain and spinal cord, and, with neurologist evaluation, help guide earlier diagnosis and treatment.
Get trusted answers about your health when you need them. SurvivorNet’s AI-powered My Health Questions tool allows patients and caregivers to get personalized, doctor-backed answers in real time.

There is no single symptom that definitively indicates someone has multiple sclerosis (MS). MRI scans play a critical role in diagnosing the condition, Dr. Lauren Krupp, a neurologist at NYU Langone in New York City, tells SurvivorNet.

Symptoms of MS are “really very varied,” Dr. Krupp says, because the disease can impact different areas of the brain and spinal cord. Symptoms can range from numbness and tingling in the face to muscle weakness to vision loss.

MS: What To Know About Symptoms

Dr. Krupp describes MS as an “immune mediated condition,” which causes the immune system to work against itself.

“We’re not exactly sure why that happens, but it probably has to do with an exposure to a virus at some point in time. And in the effort to fight off that virus, the immune system turns against itself and specifically, a coating of the nerves called myelin,” Dr. Krupp explains. “The myelin that it affects involves the central nervous system, and that’s the brain and the spinal cord.”

Because it can involve different areas in the brain or spinal cord, Dr. Krupp explains, “the symptoms can vary in location.”

Symptoms might include:

Numbness and tingling in the face
Numbness or weakness in the arms and legs
A sensation of vertigo or rooms spinning
Vision loss or blurred vision
Lack of coordination

Symptoms may affect one side of the body or, when the spinal cord is involved, both sides. In some cases, the numbness can spread and may also come with muscle weakness.

“Usually we see people who have had some neurological symptoms and they often get worked up with an MRI of the brain … the brain MRI is a really important tool,” Dr. Krupp adds.

MRI’s Role in Diagnosing MS

MRIs help doctors detect brain and spinal cord lesions linked to MS, and a neurologist’s evaluation plays a key role in confirming the diagnosis.

“[MRI has] allowed us to make the diagnosis so much more earlier and easier,” Dr. Krupp says. “In some cases, the MRI needs to be accompanied by additional tests because there are things that can mimic MS on a brain. An MRI and additional blood tests can help rule out other conditions or these mimics.”

MRI of the spinal cord can help doctors identify specific criteria for the diagnosis of MS. When someone has MS, the MRI will show very small white spots, sometimes called lesions, that are not supposed to be there.

“If you want to get more technical, these are probably plaques,” Dr. Krupp explains. “That is a term that really refers back in the old days before we had MRI … so once you make the diagnosis and the lesions have to be in a specific location, then you want to get treatment.”

There is currently no cure for MS, but there are treatments available to help modify the disease and manage symptoms.

The Next Steps After An MS Diagnosis

After being diagnosed with MS, treatment will depend on what type you have and what symptoms you are dealing with. It also helps, Dr. Krupp says, to learn, specifically, what the MRI showed and the evolving options for people in your situation.

“MS is a disorder. That’s a combination of a genetic predisposition and environmental factors. And those interactions probably have happened during your childhood or adolescence. So when you present with your first symptoms years later, there’s nothing that you did that caused it,” Dr. Krupp says.

“It’s not your fault. And the likelihood is that your offspring will not have MS … They’re at a slightly higher risk than if you did not have MS, but likelihood is they will not have it,” she adds.

Despite the stress of an MS diagnosis, Dr. Krupp offers encouraging news. People with MS are doing “amazingly well” these days.

“It’s much different than it used to be. It’s a very rewarding space for me to be in because I see how well people are doing today,” she says.

“Don’t feel without hope, because I think one, the likelihood is if you’ve just been diagnosed that you’ll do well. And there’s a lot of research going on that’s there to make things even better than they are,” Dr. Krupp adds.

Meanwhile, Dr. Nancy Siconne, Chair of Neurology, Director of Multiple Sclerosis and Neuroimmunology at Cedars-Sinai, tells SurvivorNet, explained to SurvivorNet, “There’s more than 25 different treatments available now for MS. They fall into a much smaller number of classes of medication, but I do think the big game changer was this class called B-cell depletion therapy (BCDT), and that includes Ocrevus (ocrelizumab) and Kesimpta (ofatumumab) and all the different variations that we’re excited about.

“Some people think of those as being like a heavy hitter, but we pretty much like to use that if all things being equal early on, because we do think that treating people with the most highly effective therapy being at the get-go gives the best long term outcomes.”

Dr. Siccone continued, “But there are other therapies that also are anti inflammatory and work to decrease new lesions from forming and decrease relapses, like oral therapies. And there are other sort of old, tried and true original medications, Copaxone, and the interferons, which are injectable therapies.

“We do offer all of those options to people. We do tend to steerer people toward the higher efficacy, if there are risk factors that we think make it more likely that they’re they have a higher risk of developing more severe disease.”

She explained that when patients have more spinal cord lesions—and particularly when they are older, male, or people of color—clinicians often give extra weight to those factors when deciding on the most appropriate treatment approach.