Which investigations should be performed to confirm a diagnosis of Multiple Sclerosis in suspected cases?

To confirm a diagnosis of Multiple Sclerosis (MS) in suspected cases, investigations are performed by a consultant neurologist or a specialist under their supervision ¹. The diagnosis is established using a combination of history, examination, MRI, and laboratory findings, adhering to the 2017 revised McDonald criteria ¹.

• This diagnostic process involves assessing that symptoms are consistent with an inflammatory demyelinating process ¹.
• It also includes excluding alternative diagnoses, with targeted laboratory tests potentially indicated if the history, examination, or MRI findings are atypical ¹.
• For a diagnosis of relapsing-remitting MS, it is necessary to establish that lesions on MRI scans have developed at different times and are in different anatomical locations ¹.
• Cerebrospinal fluid-specific oligoclonal bands should be sought if there is no clinical or radiological evidence of lesions developing at different times ¹.
• For a diagnosis of primary progressive MS, progressive neurological deterioration over one year or more must be established ¹.

It is important to note that MS should not be diagnosed based on MRI findings alone ¹.