10 Things to Expect at Your MS Neurologic Exam
Finding out that you may (or may not) have multiple sclerosis is a life-changing experience. You will be stressed, and that is entirely normal. There are no symptoms, physical findings or laboratory tests that can, by themselves, determine if a person has MS. Your doctor will use several strategies to determine if a person meets the long-established criteria for that diagnosis.
Brian Kelly, MD, Director of Neurology, Drexel Neuroscience Institute at Aria Health in Philadelphia, compares his diagnosing technique to an intriguing detective story, with the clues coming from “a patient’s medical records combined with candid answers about past health issues and life experiences.”
Documenting your neurological history and taking your examination may last as long as two hours, but most will be an hour or less.
Checking your reflexes
Your doctor may want to test your plantar response. He or she will scrape the sole of your foot with a pointed instrument -- heel to toes. Normally, this will cause the toes to curl downward. If the toes point up (or the big toe pops up), that’s called the "Babinski response" which may indicate neurological damage.
You may also get the familiar “little-rubber-hammer-to-the knee” test. Different results for each knee or abnormal reflex responses can also be a sign of neurological damage.
Evaluating your coordination
Problems with your coordination could indicate problems with your cerebellum -- the part of the brain that controls voluntary movement and motor coordination. Your physician will also be looking for signs of ataxia, a general term for abnormal movements and incoordination.
These tests might include:
- Precision finger taps: You take your index and middle finger and tap your thumb rapidly. Your doctor will look for speed and fluidity of movement.
- Finger-nose-finger: You quickly touch your nose and then touch your doctor’s finger. (He or she may suddenly move the finger's position to see if you can still touch it.)
- Heel to shin: The doctor asks you to take the heel of your foot and run it up and down the length of your shin.
Looking at your gait
The way you walk is a complex physiological process, influenced by a number of nervous system reflexes. By testing your gait, the neurologist can gain many clues as to what is happening with you neurologically.
You’ll be asked to walk as you normally do at first. Next, you may be asked to walk on your toes and then your heels back and forth. Also, be prepared to do a heel-to-toe walk, much like a tightrope walker or someone taking a roadside sobriety test.
Monitoring your balance
A major measure for balance is called the Romberg's Test. You’ll be asked to stand with your feet together, eyes open and hands to your side. The doctor will note how balanced your stand is. The more telling part of the test begins when you’re asked to close your eyes. Your balance is dependent upon various neurological systems working in tandem – and vision is a major factor. Without your sight, your proprioceptive function (awareness of your body in space) or vestibular functions (spatial orientation and sense of balance) need to compensate. People with MS frequently have balance issues.
Checking your vision
It’s not unusual for people with MS to experience vision problems. These can include blurred vision, loss of normal color vision, blindness in one eye, a dark spot in the field of vision, double vision, and uncontrolled eye movements (“jumping vision”). As part of assessment of the cranial nerves, your neurologist may use an ophthalmoscope, a tool to visualize the back of the eye and optic nerve, to look for signs of damage to your optic nerve.
Testing your memory
What does memory have to do with MS? Well, quite a bit for some people. Multiple sclerosis can dramatically affect your ability to remember things -- it may also make it more difficult for you to think and focus.
Your doctor may run several simple tests, like asking you to repeat a series of numbers or to answer questions about dates, places, or current events.
Assessing your emotional state
During the course of performing other tests, your physician will be monitoring your emotional condition. He or she will be paying attention to your actions and statements to determine how you’re “handling” this stressful situation. Be ready to talk about your worries and concerns. They are very natural, and you may find a measure of relief just by expressing them.
If your doctor suspects mental problems caused by multiple sclerosis, he or she may order tests designed to identify more subtle changes than the ones evident from the brief emotional evaluation.
Gauging your senses
You will likely be examined for the ability to feel pain by means of a pinprick. Other tests could involve a light touch, temperature change, or vibration (for instance, with a tuning fork). You may also be asked to sense the position of your arms or legs without looking at them.
Other evaluations may measure:
- Your sense of smell
- Your sense of taste
- Sensation in your face and scalp
- Muscle coordination in your face and neck
- Swallowing and gag reflex
- Movement of your tongue
Measuring your muscle strength
To evaluate muscle strength, your doctor will have you push with the arms and legs against the doctor's hand. Dexterity, muscle tone, and muscle control will also be tested.
Muscle weakness caused by multiple sclerosis can occur anywhere in the body. Weakness in the legs, ankles and feet can interfere with walking, while weakness in the upper body and arms can interfere with activities of daily living and self-care.
Looking for Lhermitte’s sign
Your doctor will ask you to bend your head forward. If you feel a buzzing or tingling sensation which travels down your spine or into any of your limbs, that indicates a positive Lhermitte’s sign. This is a common neurologic phenomenon seen in people with MS. Lhermitte’s sign can indicate damage to your central nervous system, such as lesions in the cervical spine, and is useful in confirming a diagnosis of MS -- and in monitoring if or how the disease is progressing.
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