Andy: I was diagnosed with MS from my CAT scan and MRI and have lesions in my brain. However, my neurologist doesn’t think it’s MS, what should I do next?
Dr Helen Ford, Neurologist: This is really about the fundamental diagnosis of MS isn’t it? And what I would say is the diagnosis of MS isn’t wholly dependent on the findings from brain scans, either from CT scan or MRI. So obviously from the question we’re not really sure about what symptoms this person has had, and that would be my starting point really, is actually are the symptoms the person’s had suggestive of MS. Interestingly, as MRI in particular is used more often, we do find changes on the MRI in the white matter, which we call high signal changes, which can appear in other conditions. So in younger people, people with migraine can have changes on their MRI scan and in older people, people can have changes in the small blood vessels which can cause similar high signal lesions. So I think one of the reasons this person may not have been diagnosed with MS is maybe because they didn’t have the clinical features of MS, or, maybe although there were changes on their MRI scan they weren’t in the typical areas of MS on the brain scan.
Andy: So this to me, and I’m not a specialist in medicine at all, but hints at MS being quite a broad pathology with kind of blurred edges where there are things that it may be difficult to determine whether it is MS or isn’t MS and a broad range within that. Almost a sense that, you know, it’s a useful label but it’s not quite as definite as it can sometimes appear as a diagnosis. Would you say that’s accurate?
Dr Helen Ford: I think the problem is that we haven’t got a single test that tells you a hundred per cent that you have MS, and that’s one of the big areas of research around things called biomarkers, blood tests for instance, that in other conditions you can have a blood test and that says you have that condition. And so in MS, although MRI is incredibly useful and it supports the diagnosis, it’s still based on what’s happened to that person and what the neurologist finds when they examine that person, supported by the MRI scan. So I think it is a really important area for research so that we do have more definitive tests.
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