Blood Testing in the Diagnosis of Multiple Sclerosis (MS)

Blood tests are typically the initial step when assessing symptoms suggestive of MS. While they cannot definitively diagnose MS, they are valuable for excluding other conditions or guiding further diagnosis.

Multiple sclerosis is a long-term disease affecting the central nervous system (CNS), where the immune system attacks the myelin sheath surrounding nerve fibers, the cells producing myelin, and the nerves themselves.

MS symptoms differ widely among individuals, commonly including vision disturbances, balance and coordination difficulties, and fatigue.

Blood tests assist in ruling out or confirming other diseases with overlapping symptoms. Often, additional diagnostics like MRI scans, lumbar punctures, or evoked potential tests are necessary for a conclusive diagnosis.

This guide explores how blood testing contributes to diagnosing MS.

What insights do blood tests provide in MS diagnosis?

Doctors often begin with blood work to identify the underlying cause of symptoms.

Early MS symptoms such as vision changes, muscle weakness, or numbness can be nonspecific and mimic various conditions, including:

• Anemia
• Thyroid disorders
• Cervical radiculopathy
• Fibromyalgia
• Vasculitis
• Meningitis
• Stroke

A complete blood count (CBC) can detect anemia (low red blood cells), signs of vasculitis (elevated white blood cells), or infections (distinct white blood cell patterns), serving as an initial screening step.

Thyroid hormone testing is also often included when evaluating MS-like symptoms.

Conditions that mimic MS symptoms

Several illnesses present symptoms similar to MS:

• Lyme disease: Causes numbness or tingling in limbs, overlapping with MS symptoms. Blood tests like ELISA and Western blot can detect Lyme infection, though not perfectly.
• Lupus: Systemic lupus erythematosus (SLE) is an autoimmune disease affecting the CNS, causing numbness, fatigue, and vision problems. Blood tests detecting antinuclear antibodies suggest lupus or other autoimmune disorders but not MS.
• Devic disease: Also known as neuromyelitis optica, this rare autoimmune disorder causes demyelination primarily in the optic nerve and spinal cord. Symptoms overlap with MS, but the NMO-IgG blood test is positive in most Devic disease cases and negative in MS.

Vitamin deficiencies that resemble MS symptoms

Certain nutritional deficiencies can imitate MS symptoms:

• Vitamin B12 deficiency: Causes demyelination similar to MS, leading to numbness, weakness, and fatigue.
• Copper deficiency myelopathy: Copper shortage can damage the spinal cord, with symptoms resembling MS. Diagnosis is through blood copper and related protein levels.

Though vitamin D deficiency doesn’t produce MS-like symptoms directly, it may increase MS risk. Many with MS have low vitamin D levels.

Vitamin D is primarily obtained from sunlight (80-90%) and dietary sources such as:

• Fatty fish (salmon, sardines)
• Beef liver
• Cheese
• Vitamin D-fortified foods (milk)

Blood tests can identify vitamin D deficiency. Maintaining healthy vitamin D levels may reduce MS risk and potentially slow progression, though research is ongoing.

Confirming an MS diagnosis

Diagnosis requires multiple tests to exclude other diseases and satisfy diagnostic criteria.

Alongside symptom review and blood tests, doctors may order:

MRI scans

MRI is a painless, noninvasive imaging technique that provides detailed views of the brain and spinal cord.

Using contrast dye, MRI detects changes like demyelinating lesions, stroke, or bleeding. It helps distinguish lesion age and activity, aiding diagnosis and monitoring.

Lumbar puncture (spinal tap)

This procedure collects cerebrospinal fluid to detect elevated IgG antibodies or oligoclonal bands, which support MS diagnosis but can appear in other diseases. Some MS patients show no abnormalities in spinal fluid.

Evoked potential tests

Visual evoked potential testing measures brain electrical responses to visual stimuli, assessing optic nerve function. It’s commonly used to evaluate MS-related nerve pathway impairments.

Eye examinations

Vision issues often emerge early in MS, frequently due to optic neuritis—optic nerve inflammation causing blurred vision, color dimming, eye pain, or blind spots.

Other MS-related eye symptoms include double vision and involuntary movements. Referral to ophthalmologists or neuro-ophthalmologists may be necessary.

Low-vision specialists

For persistent vision loss, consulting low-vision specialists can help. These experts provide tailored support and devices to improve daily functioning.

These comprehensive exams evaluate functional vision and lifestyle impact, often resulting in individualized aids.

Key MS symptoms doctors monitor

MS symptoms can be unpredictable. Common signs include:

• Dysesthesia: a unique MS symptom featuring a squeezing sensation around the torso.
• Fatigue
• Walking difficulties due to weakness, balance, or sensory issues
• Numbness on face, limbs, or body, often an early symptom
• Spasticity: involuntary muscle spasms, mainly in legs
• Vision problems such as blurred vision, poor contrast, color perception issues, optic neuritis, or eye pain
• Vertigo or lightheadedness
• Bladder dysfunction
• Sexual dysfunction
• Constipation
• Body-wide pain
• Cognitive and emotional changes
• Depression
• Dysarthria: speech difficulties or slurring

Less frequent symptoms include:

• Hearing or taste problems
• Dysphagia: difficulty swallowing
• Tremors
• Seizures
• Breathing difficulties

Steps after an MS diagnosis

Receiving an MS diagnosis can be overwhelming. Symptoms and experiences vary widely, so adapting to this chronic condition takes time.

While MS has no cure, managing the disease involves lifelong care and support.

Your healthcare team will likely expand to include a neurologist who monitors symptoms and disease progression.

Though MS can cause significant disability, many maintain a good quality of life and normal lifespan with proper management.

Joining MS support groups, either online or in-person, can provide valuable community and encouragement.

Consider the Healthline MS Buddy app, a free platform for sharing experiences and advice, available on iPhone and Android.

Connecting with others facing MS can offer comfort and insight.

Questions to discuss with your doctor

After diagnosis, collaborating with your doctor to create a treatment plan is essential. Researching MS beforehand can help you ask informed questions about therapies.

Visit the Multiple Sclerosis Resource hub for comprehensive information.

Suggested questions include:

Am I eligible for disease-modifying therapies?

The FDA has approved ocrelizumab (Ocrevus) for primary-progressive MS (PPMS). Other disease-modifying drugs target relapsing MS by reducing flare-ups and slowing progression but are less effective for progressive forms.

These medications require consistent use and may cause serious side effects. Discuss benefits and risks thoroughly with your doctor. Symptom-specific treatments, like for fatigue, are also available.

How can I best manage my symptoms?

Your doctor can recommend various symptom management strategies, often involving medications tailored to your specific issues.

The National Multiple Sclerosis Society provides lists of commonly prescribed symptom-relief drugs.

What if my symptoms worsen?

MS often follows a relapsing-remitting pattern. Severe relapses may be treated with corticosteroids, administered orally or intravenously.

If steroids are ineffective, options like plasmapheresis or Acthar Gel may be considered. Your healthcare provider will guide you through these choices.

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