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Multiple sclerosis

Last reviewed: 3 Nov 2023
Last updated: 24 Aug 2023



History and exam

Key diagnostic factors

  • visual disturbance in one eye
  • peculiar sensory phenomena
More key diagnostic factors

Other diagnostic factors

  • female sex
  • age 20-40 years
  • foot dragging or slapping
  • leg cramping
  • fatigue
  • urinary frequency
  • bowel dysfunction
  • spasticity/increased muscle tone
  • increased deep tendon reflexes
  • imbalance/incoordination
  • pale optic disk or noncorrectable visual loss
  • incorrect responses to Ishihara color blindness test plates
  • abnormal eye movements
Other diagnostic factors

Risk factors

  • female sex
  • family history of MS
  • northern latitude
  • genetic factors
  • smoking
  • vitamin D deficiency
  • autoimmune disease
  • Epstein-Barr virus
  • overweight/obesity in children and adolescents
More risk factors

Diagnostic investigations

1st investigations to order

  • MRI - brain
  • MRI - spinal cord
  • CBC
  • comprehensive metabolic panel
  • thyroid-stimulating hormone
  • vitamin B12
More 1st investigations to order

Investigations to consider

  • antibody testing for neuromyelitis optica spectrum disorders (NMOSD)
  • cerebrospinal fluid evaluation
  • evoked potentials
More investigations to consider

Treatment algorithm


acute relapse affecting function


relapsing-remitting MS

secondary progressive MS

primary progressive MS



Mary Alissa Willis, MD

Associate Professor and Chair

Department of Neurology

University of Mississippi Medical Center




MAW has been compensated for Speakers' Bureau participation with Alexion, Biogen, Bristol-Myers Squibb, Genzyme, and Genentech, and advisory board participation with Alexion, Biogen, Greenwich Biosciences, Genentech, and Horizon.


Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. We have since been made aware that Dr Stone is deceased.

Peer reviewers

Alex Rae-Grant, MD

Project Leader for Neurology

Neurological Institute

Cleveland Clinic




ARG declares that he has no competing interests.

Sarah A. Morrow, MD, FRCPC, MS

Associate Professor of Neurology

Department of Clinical Neurological Sciences

London Health Sciences Centre

University Hospital




SAM declares that she has no competing interests.

Marcelo Kremenchutzky, MD


The London Multiple Sclerosis Clinic

Associate Professor

Schulich School of Medicine

University of Western Ontario


Clinical Neurological Sciences Department

University Hospital

London Health Sciences Centre




MK declares that he has no competing interests.

Abhijit Chaudhuri, DM, MD, PhD, FACP, FRCPGlasg, FRCPLond

Consultant Neurologist

Department of Neurology

Queen’s Hospital




AC declares that he has no competing interests.

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