UC HEALTH LINE: MS Diagnosis Often Tricky

CINCINNATI—Diagnosing multiple sclerosis (MS) isn’t easy. This auto-immune disease—occurring when the body’s own natural defense system starts attacking the myelin sheath (outer lining) of nerves and neurons—takes different courses in different people.

In some cases, MS can go into remission for many years. In others, it recurs occasionally, or progresses quickly into degeneration of all motor functions that control muscles, strength, vision and balance.

Symptoms, which can vary from patient to patient, could include abnormal fatigue, difficulty walking or even slurred speech, tremors, stiffness and bladder problems.

The very progressive form of the disease can end in death.

The varying degrees of MS, and the lack of a definitive MS “blood test” or other diagnostic tool, make diagnosing the disease very difficult. So difficult, in fact, that misdiagnosis is common.

The team of physicians at UC’s Waddell Center for Multiple Sclerosis treat newly diagnosed patients and also conduct diagnostic work-ups for those with MS symptoms. They also see patients whose disease doesn’t seem to be responding to the common MS medications—which Waddell Center director Bibiana Bielekova, MD, says can sometimes be a sign of misdiagnosis.

“MS is serious,” says Bielekova, associate professor of neurology at UC. “We err on the side of caution when making a diagnosis, because all too frequently, misdiagnosis occurs.”

And a misdiagnosis of MS, Bielekova says, is not only traumatic, but can also lead to unnecessary injectable treatments that often carry side effects.

“We’ve seen patients who really don’t have MS, but for years have believed they were going to eventually die from this disease,” says Bielekova. “Not only are they traumatized, they’ve also usually been on injectable medications, for no reason, that have produced really uncomfortable side effects.”

Bielekova also cautions that patients who are diagnosed correctly could be on medications that fail to “quiet” the disease sufficiently. She says that monitoring therapeutic response by magnetic resonance imaging (MRI) and other clinical measures is important and is another way the Waddell Center team can be a resource to primary care physicians and neurologists.

“Patients may benefit from a combination of therapies, or from clinical trials of new therapies,” she adds.

Bielekova says diagnosing MS isn’t easy, and it takes ruling out other diseases with similar symptoms before a determination of MS can truly be made.

The Waddell Center team works closely with primary care physicians, neurologists, ophthalmologists and emergency physicians to manage care for MS patients. They also team with UC physicians studying and treating chronic fatigue and fibromyalgia—both conditions that can be mistaken for MS.

The Waddell Center is part of the Neuroscience Institute—a collaborative involving nine UC College of Medicine academic departments, University Hospital and independent physician practice groups. The institute is dedicated to patient care, research, education and the development of new medical technologies.

For more information, please contact Waddell Center coordinator Kimberly DiPilla at (513) 475-WADL (9235).