December 31, 2020

The benefit of a second opinion for multiple sclerosis


Diagnosing MS is a complicated process. If you’ve recently received a diagnosis of MS, here’s why getting another opinion from a multiple sclerosis specialist may be a good idea.

You’ve experienced some neurological symptoms — numbness, vision changes, balance issues or difficulty walking — and therefore consulted your primary care provider or neurologist.  After an abnormal MRI, you received a diagnosis of multiple sclerosis.

The question now is: What’s next?

“Unfortunately, there’s no single test that in isolation proves a diagnosis of MS,” said Megan Rahmlow, M.D., assistant professor of Neurology at Vanderbilt University Medical Center and a provider at the Vanderbilt Multiple Sclerosis Center. “Rather, it’s a clinical diagnosis, which is made based on knowledge of the patient’s symptoms and evidence from the MRI and a neurologic exam.”   

“A recent study indicated that nearly 1 in 5 patients referred to an academic center for MS did not have the condition,” Rahmlow said. That’s why it’s critical to seek a second opinion with a certified MS team.

MS care, resources and support

Whether you or a loved one are diagnosed with MS, experiencing symptoms or want to learn more, Vanderbilt’s dedicated Multiple Sclerosis Center and expert specialists can help.

Understanding the MS diagnosis process

Patients typically present with neurological symptoms and an abnormal MRI that shows white spots on the brain. But while MRI is the gold standard for seeing evidence of MS, there’s far more that goes into a true diagnosis of this chronic immune-mediated disease.

Specialists will take a comprehensive history and develop an understanding of the timing and source of symptoms. A thorough neurologic exam will be conducted, and additional blood work or a spinal tap may be needed.  Screening for fatigue, mood changes and cognitive problems may also be performed.

With this data, your neurologist should be able to confirm the MS diagnosis or suggest another cause for your symptoms. Once a diagnosis has been made, individualized treatment plans can be explored.  

What a multiple sclerosis center offers

At an academic MS center like the Vanderbilt Comprehensive Multiple Sclerosis Center, patients have access to specialists as well as MS-certified nurses. The neurologists are experts in other autoimmune neurological diseases that may be mistaken for MS. Patients can be referred to other specialists through Vanderbilt, if needed, to address more complex problems with memory, bladder function, mood or other issues. Needed labs can be done in-clinic, as can treatments such as steroid infusions and long-term medications that are delivered through IV.

“If a patient has already received a diagnosis of MS and has recent MRI images available to review, we can often confirm that diagnosis and get right to work on a treatment plan at the first visit,” Rahmlow said. “If the diagnosis is new to the patient, we may spend the first visit reviewing MS in more detail, explaining symptoms, connecting to resources, exploring lifestyle changes, and set up a second visit to review MS drug therapies.  It just depends on whether the patient is in the process and what his or her needs are.”

How to prepare for your first appointment

Before your appointment, be sure to obtain a personal copy of the MRI images on disc and paper copies of any relevant bloodwork or spinal fluid testing. “It’s also helpful to have an abbreviated timeline of symptoms and a list of your most important questions and concerns,” Rahmlow said.  

multiple sclerosis facts and myths

The Multiple Sclerosis Center at Vanderbilt University Medical Center evaluates and treats adults and children with multiple sclerosis and similar conditions.

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