Fino agli anni 2000 la diagnosi di sclerosi multipla si basava solamente su criteri clinici. L’introduzione della RM (risonanza magnetica), dotata di una particolare sensibilità nell’evidenziare le lesioni della sclerosi multipla, decisamente ha cambiato i criteri di diagnosi. La RM evidenzia, ogni anno un aumento di nuove lesioni 5-10 volte superiore agli episodi clinici. Questo significa che l’ attività della malattia continua anche in assenza di ricadute cliniche. Con la RM la diagnosi può quindi essere fatta meglio e prima ( potendo così iniziare più precocemente la terapia). Si sono sviluppate tecniche di analisi computerizzata della RM specifiche per la SM, che hanno permesso di stabilire, come il cosiddetto carico lesionale (cioè la somma dell’area o del volume di tutte le lesioni encefaliche di un paziente) progredisca costantemente di anno in anno e correli con l’evoluzione della disabilità del paziente.
Risonanza magnetica. Alla RM dell’encefalo e del midollo sono facilmente evidenziabili multiple caratteristiche alterazioni di segnale nell’ambito della sostanza bianca del sistema nervoso centrale (SNC).Â
Esame del liquor. Le alterazioni riscontrabile all’esame del liquido cefalorachidiano sono una modesta leucocitosi linfo-monocitaria, presente soprattutto in fase di attività di malattia. Incremento modesto della proteinorrachia. L’elemento più caratteristico è comunque rappresentato dalla presenza di bande oligoclonali  IgG all’immunoisoelettrofocusing. Questa alterazione è presente in circa il 90% dei pazienti con SM, tuttavia può essere riscontrabile anche in altre affezioni affezioni del SNC, in particolare infiammatoria. Recentemente è stato messo in evidenza come bande oligoclonali sono riscontrabili anche nelle lacrime raccolte con il metodo del test di Shirmer. la specificità del test è buono, ma la sensibilità è decisamente inferiore rispetto all’esame condotto sul liquor.
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