What Is An Attack?
- Neurological disturbance of kind seen in MS
- Subjective report or objective observation
- 24 hours duration, minimum
- Excludes pseudoattacks, single paroxysmal episodes
Determining Time Between Attacks
- 30 days between onset of event 1 and onset of event 2
How Is “Abnormality” In Paraclinical Tests Determined?
A- Magnetic resonance imaging (MRI): Three out of four:
- 1 Gd-enhancing or 9 T2 hyperintense lesions if no Gd-enhancing lesion
- 1 or more infratentorial lesions
- 1 or more juxtacortical lesions
- 3 or more periventricular lesions
(1 spinal cord lesion = 1 brain lesion)
B- Cerebrospinal fluid (CSF)
- Oligoclonal IgG bands in CSF (and not serum)
- or elevated IgG index
C- Evoked potentials (EP)
- Delayed but well-preserved wave form
What Provides MRI Evidence Of Dissemination In Time?
A Gd-enhancing lesion demonstrated in a scan done at least 3 months following onset of clinical attack at a site different from attack,
or
In absence of Gd-enhancing lesions at 3 month scan, follow-up scan after an additional 3 months showing Gd-lesion or new T2 lesion.
|
Steps in Making a Diagnosis of MS |
|
|
Clinical Presentation |
Additional Data Needed |
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2 or more attacks (relapses) 2 or more objective clinical lesions |
None; clinical evidence will suffice |
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2 or more attacks 1 objective clinical lesion |
Dissemination in space, demonstrated by: |
|
1 attack 2 or more objective clinical lesions |
Dissemination in time, demonstrated by: |
|
1 attack 1 objective clinical lesion |
Dissemination in space, demonstrated by: and |
|
Insidious neurological progression suggestive of MS |
Positive CSF and |
References:
1. 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. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001 Jul;50(1):121-7. [Medline]
Created: Aug 09, 2005
