Multiple sclerosis diagnostic study of choice

Jump to: navigation, search

Multiple sclerosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Multiple sclerosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT Scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Alternative Therapies

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Multiple sclerosis diagnostic study of choice On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Multiple sclerosis diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Multiple sclerosis diagnostic study of choice

CDC on Multiple sclerosis diagnostic study of choice

Multiple sclerosis diagnostic study of choice in the news

Blogs on Multiple sclerosis diagnostic study of choice

Directions to Hospitals Treating Multiple sclerosis

Risk calculators and risk factors for Multiple sclerosis diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

There is no single diagnostic study of choice for the diagnosis of multiple sclerosis, but multiple sclerosis can be diagnosed based on clinical presentation, MRI findings, and CSF analysis. Sequence of diagnostic studies are history and physical examination, imaging, and CSF analysis. The findings are cerebral plaques which are demyelinating areas on MRI and an elevated concentration of CSF oligoclonal bands. The diagnostic criteria for multiple sclerosis is McDonald criteria.

Diagnostic Study of Choice

Study of choice

There is no single diagnostic study of choice for the diagnosis of multiple sclerosis, but multiple sclerosis can be diagnosed based on clinical presentation, MRI findings, and CSF analysis.

Investigations:

  • Among the patients who present with clinical signs of multiple sclerosis, the CSF analysis is the most specific test for the diagnosis.
  • Among the patients who present with clinical signs of multiple sclerosis, the MRI is the most sensitive test for diagnosis.
Diagnostic results

The following findings are confirmatory for multiple sclerosis:

Sequence of Diagnostic Studies

McDonald criteria

The diagnostic criteria for multiple sclerosis is McDonald criteria.[5][6]

Clinical presentation Additional Data Needed
  • 2 or more attacks (relapses)
  • 2 or more objective clinical lesions
  • None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
  • 2 or more attacks
  • 1 objective clinical lesion
Dissemination in space, demonstrated by:
  • MRI
  • Further clinical attack involving different site
  • Presence of 1 or more T2 lesions in at least 2 of 4 of the following areas of the CNS: Periventricular, Juxtacortical, Infratentorial, or spinal cord

New criteria: Dissemination in Space (DIS) can be demonstrated by the .

  • 1 attack
  • 2 or more objective clinical lesions
Dissemination in time (DIT), demonstrated by:
  • MRI
  • Second clinical attack

New criteria: No longer a need to have separate MRIs run; Dissemination in time, demonstrated by: Simultaneous presence of asymptomatic gadolinium-enhancing

and nonenhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or Await a second clinical attack. [This allows for quicker diagnosis without sacrificing specificity, while improving sensitivity]

  • 1 attack
  • 1 objective clinical lesion (clinically isolated syndrome)
New criteria: Dissemination in space and time, demonstrated by:
  • For DIS: 1 or more T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord); or Await a second clinical attack implicating a different CNS site; and For DIT: Simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or Await a second clinical attack.
  • Insidious neurological progression suggestive of MS (primary progressive MS)
New criteria: One year of disease progression (retrospectively or prospectively determined) and two or three of the following:
  • Evidence for DIS in the brain based on 1 or more T2 lesions in the MS-characteristic (periventricular, juxtacortical, or infratentorial) regions
  • Evidence for DIS in the spinal cord based on 2 or more T2 lesions in the cord

References

  1. Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L (January 1998). "Axonal transection in the lesions of multiple sclerosis". N. Engl. J. Med. 338 (5): 278–85. doi:10.1056/NEJM199801293380502. PMID 9445407.
  2. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.
  3. Dobson R, Ramagopalan S, Davis A, Giovannoni G (August 2013). "Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude". J. Neurol. Neurosurg. Psychiatry. 84 (8): 909–14. doi:10.1136/jnnp-2012-304695. PMID 23431079.
  4. McLean BN, Luxton RW, Thompson EJ (October 1990). "A study of immunoglobulin G in the cerebrospinal fluid of 1007 patients with suspected neurological disease using isoelectric focusing and the Log IgG-Index. A comparison and diagnostic applications". Brain. 113 ( Pt 5): 1269–89. PMID 2245296.
  5. Gobbin F, Zanoni M, Marangi A, Orlandi R, Crestani L, Benedetti MD, Gajofatto A (January 2019). "2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity?". Mult Scler Relat Disord. 29: 23–25. doi:10.1016/j.msard.2019.01.008. PMID 30658260.
  6. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.



Linked-in.jpg