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Neurological Exam for MS: What To Expect

Posted on February 7, 2023

Multiple sclerosis (MS) is an autoimmune disease that develops when your immune system attacks healthy tissues in your central nervous system, mistaking them as foreign. Specifically, your immune system attacks myelin, the fatty coating on the outside of nerve cells, which may cause cognitive and motor symptoms. A neurological exam may be used to test your nerve function.

If your primary care doctor thinks you may have MS, they may refer you to a neurologist — a specialist trained in diagnosing and treating nerve conditions. As part of an MS diagnosis, the neurologist may conduct a neurological exam, which is also used to look for any neurological changes if you’ve already been diagnosed with MS.

Learning what’s included in a neurological exam can help you prepare for an upcoming appointment. You may also want to write down any symptoms you’ve been experiencing and bring the list to your appointment so you can discuss them with your neurologist.

What Is a Neurological Exam?

A neurological exam involves a set of tests that check how well your brain and nerves are working. In MS, loss of myelin on your nerves creates areas called lesions or plaques. Without myelin, electrical signals can’t be sent properly from your brain to your spinal cord and nerves. This leads to symptoms like muscle weakness, numbness, or tingling in your arms and legs.

During a neurological exam for MS, your neurologist will check your:

  • Cranial nerves, which arise from the lower part of your brain, or brainstem
  • Sensory nerves, which report information to the brain
  • Motor function (activity or movement)
  • Coordination and balance
  • Strength and muscle tone
  • Reflexes
  • Mental and emotional status

The exam typically takes an hour or less to complete. You won’t need to do much to prepare, but Cleveland Clinic recommends wearing comfortable clothing to your appointment because your neurologist may have you move around for some tests. They may also perform a physical examination to check your overall health.

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

  • Olfactory nerve — Your ability to smell
  • Trigeminal nerve — Your taste, sensations on your face, and jaw movement
  • Facial nerve — Your taste and facial expressions
  • Optic nerve — Your vision
  • Oculomotor nerve — Your eye movements

Many people with MS have issues with at least one cranial nerve. Your neurologist will perform tests to check whether these nerves are working properly. For example, to test your olfactory nerve, they may give you a tube filled with coffee or vanilla and ask you to tell them the correct scent. Other tests include:

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

Sensory Nerves

Numbness is common in MS and may affect your ability to feel some sensations. Your neurologist will perform a few tests to 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 will touch your arms and legs with either a cotton ball or a toothpick. 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 do this during your exam to check if you have Lhermitte’s sign.

Motor Function, Coordination, and Strength

Your neurologist will also test your motor function 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:

  • 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 by your neurologist 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 stretch in a muscle. 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 a nerve under your knee, which should make you kick your foot out. This movement is automatic — it happens without you thinking about it.

They’ll also check reflexes in your ankles, knees, and elbows. If your reflexes are weak, that may be a sign of nerve damage from MS.

Mental and Emotional Status

In addition to causing physical symptoms, MS can affect your mood and emotions. 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. To check your mental status, they might also ask you questions about, for example, your name, the day of the week, and where you are.

What’s Next After a Neurological Exam?

There is no one single test to diagnose MS. If the results of your neurological exam point to an MS diagnosis, your neurologist will likely order other tests to confirm it. These can include:

  • MRI scans to look for lesions on your brain and spinal cord
  • A lumbar puncture (also known as a spinal tap) to check the fluid that surrounds your brain and spinal cord (cerebrospinal fluid, or CSF) for antibodies that show your immune system is activated
  • Evoked potential test to measure the time it takes electrical signals to travel from your eyes, skin, and ears back to your brain
  • Blood tests to help rule out medical conditions that look similar to MS

Together with a neurological exam, these tests can help your neurologist make a final diagnosis.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. Here, more than 195,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you had a neurological exam? What was your experience? Share in the comments below, or start a conversation by posting on your Activities page.

    Posted on February 7, 2023
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    Luc Jasmin, M.D., Ph.D., FRCS (C), FACS is a board-certified neurosurgery specialist. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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