The diagnostic hallmark of MS is the relapse or exacerbation, which is defined as; ‘the unprovoked and unanticipated occurrence of a new symptom, or recurrence of an old symptom, lasting for a period of greater than 24 hours’.
The time and course of a relapse or exacerbation is one of the few relatively consistent and predictable aspects of the disease. Typically, a relapse will develop over a matter of days, remain constant for three to four weeks, and then slowly resolve over a period of about a month.
What happens in a neurological examination?
When carrying out a neurological investigation, the functional condition and efficacy of the nervous system are examined and tested.
Examining the cerebral nerves
In examining the cerebral nerves it is essential that facial movement and visual efficiency (eye movement) are tested. A special lamp known as an ophthalmoscope can be used for painless observation of the fundus, at the point where the visual nerves enter the eye.
Testing reflexes
Reflexes are tested with a small rubber hammer. A reflex is an involuntary reaction of the nervous system to an external stimulus. The knee-jerk reflex, for example, is a reaction of the relaxed musculature to a tap just below the kneecap. Weak, absent or excessive reflexes and different reflex behaviour in each side of the body are significant factors in an MS-diagnosis. Abdominal skin reflexes are responses to stroking the skin of the abdomen. A doctor will look for an abnormal response, sometimes referred to as Babinski's reflex, by firmly stroking the outer edge of the foot.
Testing muscular strength
Muscular strength and muscle interplay are scrutinised when investigating motor behaviour. Sensitivity is tested by assessing the perception of touch, pain, temperature, vibration and location. The ‘vegetative’ nervous system regulates automatic life-functions such as breathing or digestion. Doctors can investigate the vegetative nervous system by thoroughly examining bladder, intestinal functions, breathing and circulation.
It is also common clinical practice in diagnosing MS, for a psychological assessment of awareness, orientation, concentration, attention and overall mood, to be carried out.
