You might visit a neurologist for a neurological examination to find out whether multiple sclerosis (MS) is causing your undiagnosed symptoms. If you’ve already been diagnosed with MS, a neurological exam can also help spot any new or worsening changes in your nervous system.

In this article, we’ll cover what’s included in a neurological exam. Knowing what to expect can help you make the most of your appointment.

How To Prepare for Your Neurological Exam

Most neurological exams don’t require a lot of preparation. You can call your neurologist’s office to find out if there’s anything they want you to do ahead of time.

🗳️ How often do you undergo neurological exams for MS?

I’ve only had one, when I was diagnosed with MS.

I have one every year.

I go occasionally to check for MS progression.

I’ve never had a neurological exam.

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Before your appointment, complete any required paperwork and write down your symptoms and questions for your healthcare provider. Wear comfortable clothes that are easy to move in, and give yourself enough time to get there without rushing.

What’s Involved in a Neurological Exam?

A neurological exam involves a series of tests designed to check how well your brain and nerves are working.

In MS, damage to myelin on your nerves results in lesions or plaques. With damaged myelin, electrical signals can’t be sent properly from your brain to your spinal cord and nerves. This leads to symptoms like muscle weakness, vision changes, and numbness or tingling in your arms and legs.

During a neurological test for MS, your neurologist will likely check your:

• Cranial nerves, which control the head and neck
• Sensory nerves, which report information to the brain
• Motor function (movement)
• Coordination and balance
• Strength and muscle tone
• Reflexes
• Cognitive status

The comprehensive exam typically takes an hour or less to complete, but may take longer. The doctor may also perform a physical examination and take your medical history.

If you’re visiting the emergency room (ER) for sudden and severe MS symptoms, an ER doctor may perform a quick neurological exam to look for a possible cause.

Cranial Nerves

Everyone has 12 nerves in their head — known as cranial nerves — that are responsible for controlling many of the senses and functions of the face and neck. Each nerve is associated with a different function.

Many people with MS have issues with at least one cranial nerve.

Examples of cranial nerves that might be tested during a neurological exam (and what they control) include:

• Trigeminal nerve, or cranial nerve 5 — Facial sensations and jaw movement, like chewing
• Facial nerve, or cranial nerve 7 — Taste and facial expressions
• Optic nerve, or cranial nerve 2 — Vision
• Cranial nerves 3, 4, and 5 — Eye movements

Your neurologist will perform tests to check whether these nerves are working properly.

These tests might include:

• Making different expressions to test your facial nerve
• Following your neurologist’s finger as it moves to test your eye movements
• Reading letters and numbers off a chart to test your optic nerves

Sensory Nerves

Numbness and losing some sensations is common in MS. Your neurologist will probably check your ability to perceive different sensations.

One type of test checks your ability to tell the difference between dull and sharp sensations. Your neurologist will have you close your eyes, and then they’ll touch your arms and legs with either something soft or something sharp.

You’ll tell them whether you felt a dull or sharp sensation and where it was. Your neurologist may also use a tuning fork to see if you can feel vibrations.

Some people with MS also experience Lhermitte’s sign — an electric shock sensation that travels down your neck and into your spine. It usually happens when you bend your head toward your chest. Your neurologist may have you bend in this way to check if you have Lhermitte’s sign.

Motor Function, Coordination, and Strength

Tests of motor function are used to check your movement, balance, and muscle strength. MS plaques in your brain or spinal cord can lead to muscle weakness, which can also affect your ability to walk.

During your neurological exam, you may be asked to:

• Perform an MS balance test.
• Walk in a straight line.
• Write your name or undo buttons on a shirt.
• Touch your fingers to your nose with your eyes open and closed.
• Resist pressure applied to your arms and legs to test your strength.

If you have trouble with any of these tests, it may be a sign of MS or another neurological condition.

Reflexes

Tendon reflexes are automatic movements your body makes in response to a sudden stimulus. You’ve likely had your reflexes tested at the doctor’s office before.

A common test is the knee-jerk reflex. Your neurologist will have you hang your leg off an examination table. They’ll then tap a reflex hammer on the patellar tendon below your kneecap, which should make you kick your foot out. This movement is automatic — it happens without you thinking about it.

They may test other MS reflexes by:

• Applying a stimulus to the bottom of your foot to see if it flexes (the Babinski sign)
• Gently rubbing the muscles of your stomach to see if they tighten
• Tapping the rubber hammer on other tendons in your elbows and ankles to see if they tighten
• Flicking your middle finger to see if your thumb twitches (the Hoffman sign)

If your reflexes show abnormalities, that may be a sign of nerve damage from MS or another health condition.

MS is more commonly known for causing overactive reflexes rather than weak reflexes.

Cognitive Status

In addition to causing physical symptoms, MS can affect your mood and the way you think and remember. Changes in your cognitive function (ability to think) are common in people with MS. Your neurologist will watch you throughout your neurological exam to see how quickly you process information or if you’re having trouble concentrating.

Many people with MS also have memory problems. Your neurologist may tell you three words at the beginning of the exam. In the middle or at the end of the exam, they’ll ask you to repeat the words to test how well you remember information.

Your neurologist may also recommend a full cognitive test.

Join the Conversation

On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.

What neurological tests did you have in the diagnostic process for MS? Let others know in the comments below.