Episode Details

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.

• 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

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/

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,