Geriatric Medical Coding - Coding for Dementia

Geriatric medicine involves health concerns of the elderly population, and these cover a number of syndromes and conditions. Dementia, urinary incontinence, osteoarthritis, diabetes, cardiovascular diseases, cerebrovascular diseases, hypertension, hearing concerns, and hyperthyroidism are some of the major conditions. Geriatricians carry out various examinations and offer counseling sessions for their patients. Practitioners in this field also screen patients for various psychosocial concerns.

Dementia Codes - Medical and Psychiatric Codes

Dementia is a condition that affects a number of old people and it is defined as the progressive and severe impairment of one's brain function that interferes with one's normal functioning. Dementia is usually irreversible. It may be mild, moderate, severe or profound.

The new codes for dementia are provided in ICD-10 Chapter V: Mental and Behavioural Disorders. These codes signify various types of dementia and include medical codes and psychiatric codes. When billing for dementia, service providers should give the correct diagnostic codes for medical conditions causing irreversible dementia such as:

• Alzheimer's disease

• Frontotemporal dementia

• Multi-infarct dementia

• Parkinson's disease with dementia

• Huntington's disease

• Leukoencephalopathies

• Senile degeneration of the brain

• Mild cognitive impairment

• Dementia with Lewy bodies

• Pick's disease

• Binswanger's disease

• Creutzfeldt-Jakob disease

• Multiple sclerosis

• HIV

• Neurosyphilis

• Unspecified cerebral degeneration

• Memory loss and late effects of CVD

Psychiatric codes signify uncomplicated senile dementia, presenile dementia, senile dementia with delusional features, senile dementia with depressive features, senile dementia with delirium, arteriosclerotic dementia, dementia without behavioral disturbances, and dementia with behavioral disturbances. When coding, it is necessary to indicate whether the dementia occurred with or without behavioral disturbances such as violent behavior, aggressive behavior, wandering off and more.

Reversible types of dementia are treatable and are most often caused by conditions such as brain tumors, chronic alcoholism, infections, certain deficiencies, heavy-metal poisoning, hyperthyroidism and so on. Providers can bill for pharmacologic, physical, occupational, speech-language and other therapies that are provided for their dementia patients. Payers require that providers clearly enter their primary diagnosis as well as the secondary diagnosis that support the medical necessity of the services provided. In case the patient suffers from an illness or injury not related to their dementia, the physician's primary diagnosis recorded in the claim should reflect clearly the need for the billed service.

Factors that Have an Impact on Reimbursement

• CMS does not regard certain diagnostic codes as regular medical codes. As a result, these are not reimbursed at the usual rate, sometimes these are not paid at all. The provider has to have in-depth knowledge regarding the assignment of the correct primary and secondary diagnostic codes to ensure full reimbursement.

• Reporting all professional services in all settings such as inpatient, outpatient, home and nursing facilities, correctly using the appropriate CPT five digit codes

• Appropriate use of evaluation and management (E/M) codes or the five digit codes used to report non-procedural professional services. These codes should clearly highlight the complexity of the service provided. Tests such as gait and balance assessment, mini mental status exam, history, physical and family interview do not have their own CPT codes. So these are included under E/M.

A physician's interaction with the patient includes screening, procedure visit and visit for discussing results. For effective reimbursement, the correct diagnostic and procedural codes have to be assigned for each of these visits. During screening, the physician identifies the condition for which the appropriate diagnostic code has to be assigned. Any new problem that requires a differential diagnosis has to be documented during the procedure visit. The provider has to also ascertain whether requirements for a higher level code are met. Additional documentation includes valid diagnostic codes to justify a comprehensive exam, codes to report any co-existing conditions such as diabetes, weight loss, delirium and so on. This is important with regard to using higher levels of E/M coding. In the case of a patient with multiple problems, the doctor will have to spend more time to complete the assessment. It is the visit's complexity that would justify billing for the highest level E/M.

• 99205 - Level 5 comprehensive exam for new patient

• 99215 - Level 5 comprehensive exam for established patient

• 96116 - neurobehavioral status examination

Codes to Use for Care Management Provided

• First hour - 99358

• Each additional 30 minutes - 99359

• Telephone services - 99371-3

Tips for Accurate Coding

Review of systems (ROS), history of present illness (HPI), family, physical examination, social medical history, medical decision making, time spent for discussion of counseling, and organizing care, all these have to be taken into account when assigning E/M codes. When coding for dementia, under no circumstances should a lower level of service be reported using a higher level code. If you are to receive due reimbursement, medical necessity of a provided service is of course the primary consideration. Individual requirements of the CPT codes used are also a major criterion. The level of service reported should have sufficient supporting documentation.

How to Diagnose and Relieve a Candida Albicans Intestinal Yeast Infection

A Candida Albicans intestinal yeast infection is caused by a fungal organism which, it is believed, is present in everybody's gastrointestinal (GI) tract no matter what their age, how healthy they are or their gender.

Candida Albicans is the most common type of candida fungus/ mold, and all healthy people are immune to candida albicans. In fact, for many years a solution containing candida albicans has been injected just under the skin as a way of checking for a normal healthy immune response or for any obvious abnormalities.

The most common types of Candida Albicans are those which cause either a vaginal yeast infection in women or oral thrush which can infect anyone including young babies.

In a normal healthy host, candida present in the gut is kept under control by both the body's immune system and the friendly bacteria (probiotics) that are found in the intestinal tract.

However, problems start to occur when the Candida Albicans is allowed to colonize, multiplying and causing many of the symptoms associated with a candida infection, which range from stomach irritation to more severe even life threatening symptoms.

This can happen due to a number of reasons:

The levels of friendly bacteria in the GI tract have been reduced below a healthy amount often due to taking prescribed or non-prescribed medication for an extended period of time. This then compromises the body's natural ability to keep the candida albicans from multiplying. If a person has been taking a long course of antibiotics then it is worth keeping a close watch for any yeast infections.

A poor immune system, either through medication or through illness, can allow the candida albicans to thrive and spread. Candida infections are not unusual in HIV patients or in people who have been treated with Chemotherapy. Also a persons lifestyle can impact on their immune system, especially if they have stressful jobs or ongoing stressful personal situations.

Also, a poor diet has been attributed to an increased risk of a candida infection. This is particularly true of diets that are high in sugar.

Unfortunately as it grows the Candida Albicans can change from its relatively harmless "yeast" form, into the fungal form, which lines the GI tract walls and, if allowed to overgrow, uses its long root like tentacles to penetrate the intestinal lining and release spores into the rest of the body.

If this occurs, then a break down may occur between a person's intestinal tract and their circulatory system and so allow the introduction of allergens, poisons, irritants and toxins into the bloodstream. If the openings are large enough then partially digested proteins may also enter the bloodstream, a situation known as leaky gut syndrome.

Although it has been hard to diagnose in the past, as candida is a normal part of the GI tract flora, there have been some advances. A simple blood test known as a Candida Albicans Assay test can often be enough to diagnose whether a person has an increased level of Candida antibodies in their bloodstream.

To help a diagnosis ensure that you keep a record of any symptoms you may be suffering from and discuss them with your medical practitioner. There are a number of conditions that can have similar symptoms to a candida overgrowth, so the more you know about the condition the better chance you have of fighting it.

Treatments have been shown to be effective against candida albicans infections once it has been successfully diagnosed, and they usually include a course of anti -fungal medication, a change in lifestyle to reduce stress and an anti-candida diet.

To reduce the risk of another Candida albicans intestinal yeast infection occurring, it is important to understand the initial cause of the infection and treat that to reduce the chance of further episodes.

MS Numbness on the Left Side - What Causes It?

Of all the different symptoms of multiple sclerosis, some form of numbness or tingling sensation in at least one extremity is one of the most common. MS numbness on the left side is the symptom that seems to be the most prevalent even though the numbness can actually occur in any of your extremities. This disease affects the central nervous system by virtue of the growth of plaque that causes damage to the myelin sheath that protects the nerves in the spinal cord.

What Causes MS Numbness on the Left Side?

Multiple sclerosis is a degenerative disease of the nervous system, over time lesions will grow in various locations along the spinal cord and around the brain. Each of these lesions will cause delamination of the myelin sheath that protects the nerves that are inside the spinal cord. This damage affects the way that signals are processed and sent to the brain.

One of the symptoms of ms is numbness on the left side of the body. These symptoms along with numbness that can occur in your fingers, toes or other limbs will most likely show up in the early stages of the disease, however the vast majority of all patients will experience some level of numbness during their lives as the damage to their nervous system continues to increase.

Treatments for MS Numbness on the Left Side

No matter whether you have MS numbness on the left side or elsewhere it can be both painful and inconvenient at best and debilitating as the disease progresses. In most cases the numbness and associated pain is only temporary and will go away on its own. Many patients find that if they ignore the numbness, they can function in spite of it. This might work well for those who experience the milder levels of numbness, once the numbness becomes too painful it might be time to seek some form of treatment.

Most doctors will tell you that there is no reason to prescribe any kind of medication as there really is nothing for mild cases; the only medications are those for the worst case scenarios where the patient has become disabled due to a complete loss of feeling. You will find that eating a healthy diet and participating in a regular exercise regimen will do more to help relieve the MS numbness in the left side or any other part of your body.

Diagnosing and Living With Multiple Sclerosis

Multiple Sclerosis is possibly the most difficult disease to diagnose. The symptoms are vague and widespread, mimicking other diseases. The cause of MS is unknown and there is no cure.

Some Symptoms include:

1) Blurring or Double Vision (usually in one eye)

2) Patches of Body Numbness

3) General Weakness (usually one side of body)

4) Muscle Spasms

5) Fatigue

6) 'Pins and Needles' in extremities

7) Loss of Balance and Coordination

8) Cognitive (ability to think) difficulties

9) Overall Sensitivity to Extreme Heat or Cold

10) Loss of Sensation in Affected Extremity

There are several tests for Multiple Sclerosis. No two people experience the same symptoms, nor do they share the exact same test results. The tests for MS include:

1) MRI (Magnetic Resonance Imaging) of the Brain and Spine

2) Spinal Tap

3) Sed Rate (Lab work to show Inflammation)

4) Nerve Conduction tests (Done in your Neurologists' Office)

Your history of symptoms, family history and physical exam are also considered. You will also be checked for strength, coordination, response to stimuli and how you walk.

Once your diagnosis is confirmed you will be set up for a personalized treatment plan. Physical Therapy helps keep your muscles from atrophy (shrinkage) and stiffness, and Steroid infusions help with inflammation from the damaged nerves. Make sure you tell your doctor if you experience depression. It is important to treat the mental aspect as well.

There are new medications that help to stabilize your symptoms. They have proven to slow down the progression of the disease. Unfortunately, they are very expensive and have some unpleasant side effects. You have to use your personal situation to determine continuation of the treatments.

The biggest keys in fighting this disease are to remain as active as possible, eat a healthy diet, treat symptoms as needed and stay in touch with your local Multiple Sclerosis organizations. They are there to help you. You can speak to other MS patients and get additional support from them.

Don't get overwhelmed, it could always be worse. I had symptoms for 6 years before I was diagnosed and it was actually a relief. Having answers to my long term health problems and knowing there was help did wonders for me. I am also amazed at the support available in the MS community.

Just keep a positive attitude and stay in touch with all the help available to you. Don't fight it alone.

MS Diagnosis Criteria - What Do Doctors Look For When Diagnosing MS?

It can be very difficult for any physician to diagnose a patient with the disease multiple sclerosis. The type of damage that the disease does to the central nervous system can cause symptoms that can be reminiscent of many other neurological problems. In order to make it easier to present such a diagnosis the medical community has developed a set of MS diagnosis criteria that gives physicians the highest chance of detecting the disease at the earliest possible stage.

Initial MS Diagnosis Criteria

Over the years as research has been done the basic MS diagnosis criteria has changed to a certain degree with an eye to making it easier for physicians to catch symptoms that may seem innocuous on their own, but when put together form a pattern that can lead to early diagnosis and treatment. These criteria according to the latest information available from the MS Society of America are:

1. At least two exacerbations with a period of on e month or more between them and physical evidence of two or more lesions.

2. Two or more exacerbations with one confirmed lesion. However an MRI that shows proof of the lesion a spinal tap that results in a positive finding.

3. A single attack and 2 or more lesions as found by an MRI.

4. A single attack and 1 lesion (known as a monosymptomatic presentation) along with an MRI and a positive spinal fluid test.

5. Obvious signs that the symptoms are getting progressively worse. However this must be combined with a positive cerebro spinal fluid test and MRI evidence of multiple lesions.

Other MS Diagnosis Criteria

While the above list includes the official MS diagnosis criteria, there are many symptoms that can be indicative of the disease. Part of the problem with diagnosing multiple sclerosis is that no two people seem to exhibit quite the same symptoms at any given point in the progression. Among the more common symptoms recognized and used to recommend a patient for further testing are visual acuity problems, uncontrollable muscle spasms, weakness in one or more limbs, problems with balance and numbness or tingling in one or more limbs.

These symptoms are among the very first criteria for MS diagnosis and are used by many doctors to recommend that a patient seek further testing. This testing will most likely include blood tests to rule out many other problems whose symptoms mimic those of multiple sclerosis. An MRI of both your head and spinal cord to see if there are any lesions and an evoked response test to see how your brain responds to certain stimuli and whether or not there is any impairment evident.

There is no one single test for MS and the criteria for MS diagnosis leave room for individual diagnosis, but are specific enough to give medical professionals the highest possible chance of catching this disease at the earliest stage. The early it can be diagnosed the more likely a person is to be successful in getting the treatment they need.

What Exactly Is Multiple Sclerosis?

• 
  Multiple Sclerosis is an autoimmune disease

Multiple sclerosis (MS) is a neurological disorder that affects around 2.5 million people worldwide. In this disorder, the body's own immune system acts against the central nervous system - the brain, spinal cord and nerves. Such a condition is referred to as an autoimmune disease. Normally, the immune system defends our body from the attack of foreign elements. The cells concerned with immunity target and destroy the foreign bodies like bacteria and other pathogens. But in MS, the immune system mistakes myelin (a fatty coat that protects the nerve fibers) for a foreign substance and destroys it. That is why Multiple Sclerosis is also called a demyelinating disorder.

Why does the body offend the myelin coat?

It is still not clear why the immune system attacks the myelin substance that is native to the human body. Scientists suggest environmental and genetic factors for this behavior of the immune system. Some researchers also consider that certain viruses can cause this disease. However, there is no strong scientific background for this hypothesis.

• 
  Multiple Sclerosis has no specific pattern of presentation

The disease presents with different symptoms in different patients. There is no definite order in which the symptoms appear. In some patients, the symptoms are mild and go unnoticed during the early stages while in others, disturbing symptoms occur earlier and may last for some time. Though the disease can affect people of all ages, the initial symptoms usually show up between 20 and 40 years of age.

The symptoms depend upon the part of the nervous system affected. The symptoms commonly include visual disturbances, tingling sensations, numbness, bladder and bowel disturbances, dizziness, fatigue, loss of balance, cognitive disturbances, emotional changes, muscle cramps and sexual dysfunction.

Another peculiarity of MS is that it is not possible to predict the disease progression. Some people may show up a symptom that persists for a while and then subsides. They may not have any other symptom for years. While in others, there may be a rapid progression of the disease so that they may show up with many symptoms within a limited period.

• 
  Multiple Sclerosis is difficult to diagnose

There is no specific laboratory test to confirm the diagnosis of Multiple Sclerosis. The symptoms of MS are not specific for this disease. Furthermore, it is very difficult to establish this diagnosis after a single episode of symptomatic attack. The other possible causes of these symptoms need to be ruled out before arriving into the diagnosis of MS. There are various criteria on which the disease can be confirmed. A careful neurological examination is a fundamental requirement for an accurate diagnosis of MS.

It is also necessary that the damage caused to the central nervous system is confirmed by additional methods like imaging techniques, CSF analysis and other specific neurological studies. MRI is the best imaging technique to confirm that the damage has occurred. Another advantage of MRI is that it can pinpoint the site of damage. This when corresponds to the neurological symptom present in the patient, the diagnosis is confirmed.

• 
  Multiple Sclerosis has no curative treatment at present

The available treatment options focus on reducing the frequency and severity of symptoms and slowing the disease progression. Medicines for symptom-management, disease modifying drugs, alternative therapies and diet and lifestyle changes are all aimed at improving the 'quality of life' of the suffering patients. Unfortunately, there is no known cure for the disease at the moment.

Diagnosing MS - How a Diagnosis is Made

Multiple sclerosis can be a devastating disease for anyone who is diagnosed with it. Currently there are no known cures for the disease; however there are a variety of therapies and medications that can help the person diagnosed with MS lead a full life. There is no one test that can be performed for diagnosing MS that can provide proof positive that a person has the disease. Medical professionals do however have a set of criteria that they use to make a diagnosis, but even with this set of established symptoms there are no guarantees.

How is the Diagnosis Made?

Multiple sclerosis can be extremely difficult to diagnose, if you or your family doctor have reason to suspect that you may have MS you need to see a specialist. You will need to be seen by a neurologist who specializes in this disease so that he can fully evaluate your symptoms. According to medical research as many as 10% of patients who are referred for further testing to diagnose MS have another problem or condition that imitates the disease such as multiple strokes, lupus or an infection of the brain.

To make diagnosing MS accurate the specialist will take a close look at your overall medical history and perform a complete neurological evaluation of your spinal cord and brain with a variety of different tests. It requires a highly skilled doctor in this field to not only perform the examinations, but to ask you the right questions so that he can evaluate all of the signs and symptoms you have exhibited. He may also order an MRI to look for lesions, a spinal tap or lumbar puncture to examine your spinal fluid and an evoked potentials test to check for nerve damage.

What Criteria are used?

Because the disease manifests itself in so many different ways the medical field has established certain criteria used in diagnosing MS to help make the chances of early detection and treatment much higher. These include noting that the average onset occurs between the ages of 20 and 50, noticeable signs and symptoms of brain or spinal cord damage according to a know list and signs of at least two lesions on the brain or spinal cord as seen in and MRI.

The patient must also have recorded instances of more than two episodes of the listed symptoms that have lasted more than 24 hours that were more than one month apart and there should be no other way to explain the symptoms described. Once an accurate diagnosis is made the doctor can then recommend a treatment regimen to help the person cope with this degenerative disease. In many cases if it is cause early enough a patient will be able to lead a full life with minimal exacerbations.

Multiple Sclerosis Information - The Key to Learning to Live With MS is Good Information

Being diagnosed with Multiple Sclerosis is going to be a life altering event as finding out that you have an "incurable" disease is certain to leave you feeling completely at a loss as to where to turn or what to do. As with any diagnosis of a disease like this the best way to come to terms with it and learn how to get on top of it is to educate yourself. The best thing you can do for yourself is to find as much information on Multiple Sclerosis as you can and use it to your advantage.

Where Do I Look?

Because MS has become so prevalent in the Western World there is a plethora of information available regarding not only the disease itself, but also on how to cope with it and what changes you can make in your lifestyle to help. These changes can help you not only learn how to cope with Multiple Sclerosis, but if you follow the right advice can actually send the disease into remission and keep you symptom free for many months if not years at a time.

1. Your Doctor: Once you have been diagnosed with MS your doctor or specialist is likely to be a wealth of medical information on Multiple Sclerosis. He may be able to help you understand more about what the disease does to your body and what you can expect to occur over time as the disease progresses.

2. The Internet: Thanks to the Internet there is a wealth of information available covering every aspect of MS from what we know about the disease to the many different ways patients are changing their lifestyles that is dramatically impacting how much the disease is affecting them. The only thing you have to be careful of with the Internet is that there is not only a mass of good information, but there is just as much inaccurate information so you should be prepared to cross reference everything to make sure that what you are reading is accurate.

3. Support Groups: These may be your most valuable resource for information regarding alternatives to treating your disease with medications. There are many different ideas when it comes to treating MS some of which are considered alternative and others that involve making sweeping changes to your diet. In a good support group you will learn what others are doing to make their lives better even thought they all have the same basic disease their methods of dealing with it are all going to be different.

Everyone is Different

While Multiple Sclerosis is only one disease, the way it affects people is different in everyone, this is part of what makes treatments that work so hard to come up with. It is also what makes people become so creative in the way that they learn to cope with and overcome it. Read as much information on Multiple Sclerosis as you can and you will find that you can learn to live with the disease and in many cases control it instead of letting it control you.

Diagnosed With MS - What You Should Do Next

Once you have been diagnosed with MS it is time to find out everything that you can about the disease. The most common reaction is one of dread; people tend to think that a diagnosis of multiple sclerosis is a death sentence. In the vast majority of cases this is simply not the case; however you will need to be prepared to make changes in your lifestyle. These changes can make a significant difference in the impact that the disease will have on your body.

Learning is Important after you have Been Diagnosed with MS

As with any illness or disease the more you know about the disease, the easier it will be to learn how to cope with it. There is a wealth of information available that will help explain every aspect of the disease. Being diagnosed with MS is the beginning of an educational journey that will take you down many different paths as you search for the best ways to cope with the disease. Knowledge is power and with MS this is a very true statement.

While the medical community is not exactly sure what causes multiple sclerosis and are equally unable to cure it at the moment, research is very much an ongoing process. For those who are currently being diagnosed with the disease the choices in treatments have grown significantly in the last few years. These treatments are aimed at slowing down the progression of the disease and reducing both the number and severity of any relapses you might have. By doing your own research you can stay abreast of these new treatments.

Adjusting Your Lifestyle

After being diagnosed with MS your doctor is likely to tell you that you are going to have to make several important changes in the way you lead your life. For most patients with this disease the most common symptom that has to be dealt with is fatigue. Your body's immune system is busy trying to fight off a nonexistent disease, this is the basis of the disease, and this can be very tiring since it never stops fighting. You will need to learn how to budget your energy so that you do not over exert yourself and bring on more exacerbations.

Your diet will need to be adjusted as processed foods and those that are known to cause inflammation should be eliminated from your diet. You should start eating foods such as leafy green vegetables, fish and other foods that are low in fat but high in essential fatty acids have been proven to help reduce the severity and quantity of any relapses you might have. The key being able to cope with the disease after you have diagnosed with MS is learning as much as possible about the disease and making the right choices.

I have benefited greatly from a book which has examined the link between what we eat and multiple sclerosis. If you would like to know what foods are attacking your body, what supplements you must take and how to create the energy that you need, then this book is a must read. Reverse Multiple Sclerosis

What Are Early Multiple Sclerosis Symptoms?

As multiple sclerosis is a disease that affects the central nervous system the answer to "What are early multiple sclerosis symptoms?" is not going to be the same for everyone. The disease itself attacks the myelin sheath surrounding the spinal cord and the brain differently for every person that is diagnosed. Because of this the symptoms themselves can manifest in many different ways. In general the first time a person experiences an episode or exacerbation is between the ages of 20 and 40.

What are Early Multiple Sclerosis Symptoms that are Obvious?

Rather than asking "What are early multiple sclerosis symptoms", you might be better off asking what the most obvious and easily recognizable symptoms are. The symptoms that occur are dependent upon where the lesions associated with MS are and how much damage they have done. However, here are the most commonly recognized symptoms of the disease:

1. Balance and Coordination: This is most seen as the person having difficulty walking and manifests as an unsteady gait and keeping their balance. It can also be seen as tremors in the hands making it hard to grasp and control small objects.
2. Tingling and Numbness: The patient will feel a burning or tingling sensation in their limbs or they may feel numb. They may also experience feelings of intense heat or cold. If L'Hermmitte's sign is present a burning electrical shock may be felt running down the back and legs when they bend their neck forward.
3. Muscle Weakness or Spasticity: At times the patient may feel a certain level of weakness in his limbs or they might feel heavy and cause unusual clumsiness. Many patients also experience muscle spasms especially in their legs.
4. Vision Problems: These range from inflammation of the optic nerve known as Optic Neuritis to blurred or double vision. Temporary loss of sight can occur and extremely rarely sight can be lost permanently.
5. Fatigue: This is considered to be the number one early symptom of MS and is also the most debilitating. While it may only occur in up to 20% of all patients in the early stages, as the disease advances, all patients will have to contend with excessive fatigue.

This is a basic list to answer the question "What are early multiple sclerosis symptoms?" Again as the disease affects every patient differently, if you experience any of these symptoms you should seek medical testing to begin diagnostic testing. The only chance you have to overcome this potentially devastating disease is to start treating it as early as possible.

Early Diagnosis of Multiple Sclerosis: Difficult But Important

The principal dilemma in current management of multiple sclerosis is that while early diagnosis enables damage-sparing treatment to begin, diagnosing MS too early increases the likelihood of treating people who don't actually have the disease. Current disease-modifying drugs are all given by injection and cost about $14,000 per year. Apart from being inconvenient and expensive, there is some risk of harm from them which, if the patient doesn't actually have MS, occurs without any offsetting benefit.

The dilemma would not be great if multiple sclerosis was easy to diagnose, but unfortunately MS is among the most difficult diagnoses in all of medicine to make, at least while still in its early stages. Early in the course of symptoms, MS can resemble other conditions; moreover, other conditions can resemble MS.

Affecting 2.5 million people worldwide and 350,000 people in the U.S. alone, multiple sclerosis is not exactly a rare disease. It affects women at least twice as often as men and begins early in adulthood with most cases starting between the ages of 20 and 40.

MS is a so-called autoimmune disease, meaning that a person's immune system--ordinarily useful and essential in fighting off infections--becomes overactive and attacks the individual's own bodily tissues. Rheumatoid arthritis is another example of an autoimmune disease, but in MS the immune attack is not directed against joints as it is in rheumatoid arthritis. Instead, the immune system attacks large clusters of nerve-fibers generally deep within the central nervous system which includes the brain and spinal cord.

These attacks can produce a wide variety of symptoms depending on what the usual function was of the nerve-fibers that are under attack. When the attacked nerve-fibers have to do with vision, the symptoms are visual, like loss of visual clarity or even doubling of vision. When the nerve-fibers are involved with the process of bodily sensation, then the symptoms can be numbness or tingling. In fact, visual or sensory symptoms are the most common initial symptoms in multiple sclerosis. But initial symptoms might instead consist of dizziness, weakness, clumsiness or difficulty with urination. The sheer diversity of early symptoms that can be due to multiple sclerosis is one of the chief difficulties in recognizing it for what it is and properly diagnosing it.

It's useful in this regard to consider the twin issues of "false-positives" and "false-negatives." In short, every medical test and every diagnosis is subject to these errors. False-positive means that a test or a doctor indicates that a disease is present when it is, in fact, absent. A false-negative error occurs when a test or a doctor indicates that a disease is absent when it is, in fact, present. Despite the increased confidence that expanding medical knowledge and ever-more sophisticated tests provide, false-positives and false-negatives are a fact of life and still apply to every test and every diagnosis.

In multiple sclerosis there are three cornerstones to the diagnostic process. In usual descending order of importance they are the clinical evaluation, magnetic resonance imaging (MRI) scanning and examination of the cerebrospinal fluid. Each of these is important in its own way, but one component almost never stands on its own merits, requiring one or both of the other components for corroboration.

The clinical evaluation refers to the time-honored process in which the physician elicits the history of the symptoms and performs a physical examination. The physical examination consists mainly of the neurological examination, which is a battery of mini-tests that inventories the performance of different components of the nervous system.

Even a test as high-tech and powerful as the MRI scan can lead to diagnostic errors. False-positives often occur when a patient has a scan for a totally unrelated reason--like headaches, for example--and has pockets of increased signal within the brain for which the radiologist raises the possibility of multiple sclerosis. When the abnormal scan leads to consultation with a neurologist, the neurologist often determines that multiple sclerosis is out of the question, and the areas of increased signal are either benign or due to another problem entirely. MRIs less frequently produce false-negatives for multiple sclerosis, but even so, this imaging test is believed to show just the tip of the iceberg in this disease, failing to demonstrate important changes that occur at the microscopic level.

Examining the cerebrospinal fluid (CSF) is another valuable tool in diagnosing MS. The CSF bathes the inside and the outside of the brain and the outside of the spinal cord, so its cellular and chemical composition often reflects what's going on within those structures. CSF is obtained by means of lumbar puncture, also known as spinal tap, a safe procedure in which a needle is inserted through the lower back and into the CSF space. The fluid is collected as it drips out the back of the needle. In cases of active MS there are usually abnormal proteins produced by the immune system that can be detected and measured in the CSF. However, here too there are false-positives and false-negatives, so that some people with abnormal proteins don't have MS and other people with normal proteins still do have the disease.

So the diagnostic process--including clinical evaluation, MRI scanning and CSF examination--is fraught with the possibility of error at each step of the way. Yet there is considerable incentive to make the diagnosis as early in the disease as possible (which is also when the risk of diagnostic errors is greatest) in order to initiate treatment that tames the out-of-control immune system. Sifting through the diagnostic information to make a timely and accurate diagnosis almost always requires the assistance of a neurologist, and even with the help of these specialists in disorders of the nervous system, sometimes the diagnosis gets revised as time passes and clues become more definite.

(C) 2005 by Gary Cordingley

Multiple Sclerosis Signs & Symptoms

Due to the fact that multiple sclerosis is a progressive disease that affects the nerves of the brain and spinal chord, it can produce a wide variety of numerous symptoms that primarily depend upon what specific nerves are affected.

Multiple sclerosis is typically difficult to diagnose in its beginning stages because of the fact that the symptoms will come and go and may remain dormant for months at a time. This disease typically begins to develop in individuals who are between the ages of twenty and forty years old and tends to occur in more women than men; however, it can develop at any age.

Early Signs and Symptoms

In the early stages of multiple sclerosis an individual may begin to experience a tingling sensation or pain in some areas of the body. An individual may also experience numbness that will only occur on one side of their body at a time or this numbness may only affect the lower half of the body.

Vision problems are also a common symptom of the onset of MS and the sufferer will experience blurry vision, double vision, or a loss of vision in one eye and pain within the eye during movement. Weakness is also another common symptom of multiple sclerosis and may occur in only one limb or multiple limbs and the individual may also experience a loss of their balance at times.

Symptoms that occur during the Later Stages

The disease of multiple sclerosis is progressive and causes the slow deterioration of the nerves within the spinal chord and brain; therefore as the nerves become increasingly more damaged over time, symptoms and complications that are more severe will develop. These include extreme fatigue that not only affects the individual physically, but mentally as well.

The muscle weakness will become more significant and the muscles will also spasm at times or become stiff. Dizziness may occur that causes the patient to feel off balance or have vertigo which is the sensation that everything is spinning around them.

Many individuals in the later stages of MS will also have significant issues with their memory and thought process. This will cause the inability to reason correctly and remember important events and dates as well as cause an impairment of cognitive skills.

Another common symptom that occurs in many patients with multiple sclerosis is a sensitivity to heat that interferes with things like taking a hot shower. Walking may also be difficult primarily due to muscle weakness, dizziness, or the numbness that can occur in the feet. Speech and swallowing can also become difficult when the nerves that control these functions become damaged by MS.

The signs and symptoms of multiple sclerosis often are triggered or become more significant when an individual experiences an increase in body temperature. In most cases multiple sclerosis is not diagnosed until an individual seeks help for two or more of these symptoms.

These symptoms do not always indicate that an individual has multiple sclerosis as they can also be indicative of many other conditions or diseases, however, if you are experiencing any of these signs or symptoms it is essential that you contact your primary care physician or health care provider for an evaluation as soon as possible.