Not a substitute for medical advice. Information on the state of research, not a treatment recommendation. Voices and presenters are AI-generated, not doctors. More (German)
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MS basics

MS diagnosis: how multiple sclerosis is established

The MS diagnosis rests on the conversation, the neurological examination, imaging and laboratory values. Here you can see which tests are part of it and what doctors look for.

This text provides general information and is no substitute for medical advice. Diagnosis and treatment belong in the hands of neurologists; never stop prescribed medication on your own. Rules, approvals and guidelines differ from country to country; sources marked (German) refer to Germany.

The path to diagnosis

No single test proves MS. The neurologist assesses the whole picture:

  1. Medical history: which complaints were there, when and for how long?
  2. Neurological examination: reflexes, strength, sensation, coordination, eye movements.
  3. MRI of the head and spinal cord, usually with contrast agent. It shows inflammatory areas (lesions).
  4. Cerebrospinal fluid (CSF) test: signs of inflammation in the central nervous system, for example oligoclonal bands.
  5. Evoked potentials: measuring how quickly nerve pathways respond, for example the visual pathway (VEP).
  6. Blood tests, to rule out other conditions.

The McDonald criteria

The McDonald classification (last revised in 2017) is used internationally. The core is evidence that damage has occurred in different places (dissemination in space) and at different times (dissemination in time). MRI can often show both at the first examination. Oligoclonal bands in the CSF can also support the diagnosis.

Differential diagnoses

Similar complaints and MRI findings also occur in other conditions, for example neuromyelitis optica spectrum disorders, MOG antibody-associated disease, vascular changes or infections such as Lyme disease. That is why ruling out other causes is part of the diagnosis.

After the diagnosis

If you have just received the diagnosis, “Newly diagnosed with MS” (in German) can help. How treatment continues is covered under MS treatments at a glance.

Frequently asked questions

How certain is the MS diagnosis?

With the McDonald criteria, MS can often be established early and reliably today. In unclear cases, tests are repeated after some time.

Can MS be recognised on MRI alone?

MRI is the most important test but is not enough on its own. What counts is the combination of symptoms, MRI, CSF findings and ruling out other conditions.

Is a lumbar puncture dangerous?

It is considered safe. Some people get a temporary headache afterwards. Your doctor will explain it to you beforehand.

Sources

As of: 2026-11-02. More basics: What is multiple sclerosis (MS)? · MS symptoms: early signs and typical complaints · MS treatments at a glance.