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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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

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

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

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