#177: A First Diagnosis of Multiple Sclerosis: Symptoms, Tests, and Next Steps

What may be the first signs of multiple sclerosis? Which tests are needed to diagnose MS, and what happens after the diagnosis?

In this episode, I speak with Dr Datzmann, Senior Consultant at the MS Centre of Bezirksklinikum Mainkofen in Germany. He explains why diagnosing MS is like putting together a puzzle. Important pieces include the medical history, neurological examination, MRI scans, cerebrospinal fluid testing and the exclusion of other conditions.

We also discuss common early symptoms such as optic neuritis, sensory changes, walking difficulties, bladder problems and double vision. Dr Datzmann explains why a diagnosis may not always be confirmed after the first clinical event and how he supports people during this emotionally challenging time.

Most importantly, he emphasises that MS does not automatically mean needing a wheelchair and that effective treatment options are available.

This episode is an adapted English version of an interview originally conducted in German in February 2021.

In This Episode

• Common early symptoms of multiple sclerosis
• Optic neuritis and sensory changes
• The role of the neurological examination
• MRI scans of the brain and spinal cord
• Cerebrospinal fluid testing and oligoclonal bands
• Conditions that may resemble MS
• Clinically isolated syndrome and the first relapse
• Communicating the diagnosis with empathy
• Treatment and follow-up care after diagnosis
• Cooperation between neurologists and specialised MS centres

Diagnostic Update

Since the original interview, the diagnostic criteria have been revised. The 2024 McDonald criteria, published in 2025, include additional imaging and laboratory biomarkers that may support an earlier and more accurate MS diagnosis in appropriate cases. This means that some people may receive a confirmed diagnosis sooner instead of remaining diagnosed with clinically isolated syndrome for an extended period.

Learn more in my dedicated episode and article: https://ms-perspektive.de/en/139-2024-mcdonald-criteria/

Treatment Update

Modern MS care increasingly considers early use of highly effective treatment for people with active disease. This approach is sometimes described as "hit hard and early" or "flipping the pyramid". The aim is to use the early window of opportunity to reduce inflammatory activity and protect the brain and spinal cord.

To learn more, see Sequencing and Escalation in MS Treatment with Prof. Tomas Kalincik, Immunotherapy for MS with Prof. Tjalf Ziemssen and Brain Health: Time Matters in MS.

Blog Article

Read the full adapted English interview: https://ms-perspektive.de/en/177-first-diagnosis-ms/

Chapters

00:00 Introduction
00:57 Dr Datzmann's path into neurology
02:10 Common first symptoms of MS
04:35 How multiple sclerosis is diagnosed
06:34 Understanding MRI findings
07:51 Ruling out other conditions
08:59 Can MS be diagnosed after the first relapse?
10:44 How long does it take to receive a clear diagnosis?
12:27 Communicating the diagnosis with empathy
13:07 Explaining multiple sclerosis clearly
14:46 Why MS does not automatically mean a wheelchair
16:46 Personal experiences with MS treatment
18:23 Treatment advice after diagnosis
20:14 Follow-up care with a neurologist and MS centre
20:51 MRI, blood and cognitive monitoring
22:39 The Mainkofen MS Centre
24:09 Closing thoughts

Conclusion: A Careful Diagnosis Creates the Basis for Early Treatment

A first diagnosis of multiple sclerosis is based on several pieces of evidence. These include a detailed medical history, a neurological examination, MRI scans of the brain and sometimes the spinal cord, cerebrospinal fluid testing, and the exclusion of other conditions.

The final diagnosis may not always be clear after the first neurological event. Regular follow-up checks can help identify further disease activity at an early stage.

A calm and understandable conversation is just as important as the medical tests themselves. The diagnosis can initially feel frightening, but it does not automatically mean that an active and independent life is no longer possible.

Today, a range of effective MS treatments is available. Together with specialised neurological care, they can help reduce inflammatory activity, protect neurological function, and maintain quality of life over the long term.

About the MS Centre

At the time of the interview, the Mainkofen MS Centre primarily served patients from Lower Bavaria and neighbouring regions. For current information about appointments, referrals, and contact details, please visit the clinic's official website.

https://www.mainkofen.de/neurologie/multiple-sklerose/

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See you soon and try to make the best out of your life,
Nele

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