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    You are here : Home » About MS » Multiple Sclerosis Diagnosis

    Multiple Sclerosis Diagnosis

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    MS DiagnosisPeople often wonder why it is sometimes difficult for medical advisers to decide on a diagnosis or, at any rate to tell a person the name of the disease or condition involved. This is not an uncommon experience in Multiple Sclerosis.

    Also many other conditions may produce symptoms almost indistinguishable from MS symptoms.

    So, what is diagnosis?
    The process of arriving at a diagnosis should result in an understanding by the doctors of the nature of the condition, which should be passed on to the patient in a caring and positive manner. In fact, it is not always as easy as that to reach a definite diagnosis and explaining to the patient may sometimes not be as simple as people would like. There may be a delay or even a wrong diagnosis.

    It is important to keep in mind that the common symptoms of MS can also be symptomatic of other conditions so the list that follows of ways in which Multiple Sclerosis shows itself should be read with this in mind. It is also true that there is no set pattern and some people will experience symptoms that others will not and these can also vary from time to time, occurring singly or in combination.

    Some symptoms are obvious to people you meet, like walking problems, but others are not and can be difficult to describe to other people, like fatigue and sensory disturbances.

    Some people rarely have attacks and their symptoms are quite slight, while other people have problems that are moderate, severe or extreme during attacks. Difficulties can arise even between attacks although some relief may be experienced. Other people experience a slow, sometimes almost imperceptible change in condition with no obvious attacks.

    Unfortunately there is no one single test or procedure that can be used to accurately diagnose MS. It is usually based around a number of things such as looking into medical history and a series of tests. Other conditions need to be ruled out before they can confirm a diagnosis. The process of diagnosing may well include some or all of the following:

    Neurologist examination
    The process usually starts with a referral to a Consultant Neurologist. Medical history and current symptoms will be covered and some simple examinations such as checks on movement, vision, coordination, balance, reflexes etc. The information from these will help to indicate where in the central nervous system damage may have occurred and whether further tests are needed. If the patient history and examinations suggest MS, more tests will look for the evidence within the body. There are set criteria that need to be met to positively identify MS.

    Further tests that may be suggested are as follows:

    MRI scanning
    MS MRI Scan
    An MRI, or Magnetic Resonance Imaging, is used to identify any areas of the brain or spinal cord that may have scarring. Magnetic and radio waves are used, meaning that there is no exposure to x-rays or any other damaging forms of radiation.

    Lumbar Puncture
    Lumbar Puncture
    A lumbar puncture (also known as a spinal tap) is a procedure where a sample of the
    cerebrospinal fluid is taken and analysed to test for any abnormalities that can indicate MS. CSF is the fluid that supports and protects the brain and spinal cord.

    Evoked Potentials
    Evoked Potentials
    These are very simple electrical tests that measure the time it takes for nerves to respond to stimulation. Visual Evoked Potentials are the most commonly used in the diagnostic process. It is important to keep in mind that these tests do not always give a conclusive result. Mostly people with MS will show some lesions or areas of inflammation on a MRI but there are still a small proportion of people whose MRI shows nothing at all. As with a lumbar puncture, there are around 5% of people with MS with a negative result.

    In summary, a diagnosis of MS is still undertaken through your medical history, clinical and neurological assessment and judgment by a neurologist.

    After diagnosis…
    Once a diagnosis is confirmed, thoughts about life may/will change. It is difficult to wonder if every little ‘twinge’ is another sign or symptom of disease progression or the start of another attack. Everyone is likely to have thoughts like these at some point and they are only to be expected. Nevertheless, having MS does not mean that you will not have any other illness or condition and it often happens that MS symptoms are worse when people are feeling ‘under the weather’ in other ways, like having a simple cold.

    Steps can be taken on how to manage certain symptoms, treatment plans set up to try to help reduce attacks and/or progression. Other drugs may be available to help manage specific symptoms. The patient may well be put in touch with a MS Nurse.

    The MSRC Advisory Service is available during office hours for any information, advice and help required (01206 226500). The MSRC Telephone Counselling Service is available to the patient and to their families/friends if more support is needed (0800 783 0518 (Option 1)). All calls are taken by people experienced with dealing with MS directly, by them either having it themselves or knowing someone personally. Complementary therapies are available through the MS Therapy Centres situated around the country. There are a range of different therapies available. Call the MSRC office for more details (01206 226500).

    The point of diagnosis can be a very difficult time; is something new to be accepted and life adjustments may need to be made. MSRC can help where possible to make this time easier, provide the support that is often needed and help provide the options available for the individual to choose the right pathways for themselves.

    International panel revises 'McDonald Criteria' for diagnosing MS

    MS DiagnosisAn international panel has revised and simplified the “McDonald Criteria” commonly used to diagnose multiple sclerosis, incorporating new data that should speed the diagnosis without compromising accuracy.

    The International Panel on Diagnosis of MS, organized and supported by the National MS Society and the European Committee for Treatment and Research in Multiple Sclerosis, was chaired by Chris H. Polman, MD, PhD (Free University of Amsterdam).

    “Treating MS early and effectively is likely our best way to prevent permanent damage to the nervous system, so speeding the diagnosis of MS without compromising accuracy is a key goal,” stated National MS Society Chief Medical Officer Aaron Miller, MD, Professor of Neurology and Medical Director of the MS Center at Mount Sinai Medical Center in New York City. “These updated diagnostic criteria appear to achieve this goal.”

    The National MS Society has developed materials to help neurologists understand and apply the 2010 revised diagnostic criteria in practice. These include plans to produce pocket cards summarizing the new criteria.

    Background: MS is a chronic, often disabling disease that attacks the central nervous system. Its progress, severity, and specific symptoms are unpredictable and vary from one person to another. Determining if an individual has MS can be difficult because there is no single test that can accurately determine the diagnosis. Generally the process of diagnosis involves obtaining evidence from patient history, clinical examination, a variety of laboratory tests, and magnetic resonance imaging (MRI) scans, all intended to rule out other possible causes of disease and to gather data consistent with a diagnosis of MS.

    The newly revised 2010 McDonald Criteria incorporate updated information on using MRI as a tool for speeding diagnosis.

    The McDonald Criteria for Diagnosis of MS were originally published in 2001. They were named for the chair of the original panel, the late neurologist W. Ian McDonald, MB, ChB, PhD. Dr. Polman chaired the panels responsible for the 2005 and 2010 revisions. The previous versions have been the subject of extensive debate and testing. A significant body of new information about the utility of the Criteria has been published. The International Panel reconvened in May 2010 in Dublin to consider these new data and to develop consensus for revising and updating the McDonald Criteria, with an eye toward speeding and easing diagnosis without compromising accuracy.

    Diagnosis of MS — The Basics Still Apply: The diagnosis of MS is a partly subjective process, and is best made by an expert who is familiar with the disease and who can interpret imaging and laboratory evidence that can supplement the clinical diagnostic process. The requirement remains that there must be no better explanation than MS for the clinical and laboratory findings — other possible diagnoses must be considered and excluded. (Go to this link for free access to published guidelines on the differential diagnosis of MS (Multiple Sclerosis 2008 14;9:1157-1174

    The key to an MS diagnosis has been, and remains, the objective demonstration of dissemination of typical disease signs and symptoms in time and space. The 2010 revisions maintain this requirement, but offer several ways of using imaging to determine dissemination. It remains the case that while the use of paraclinical and laboratory examination can speed an MS diagnosis, a solid diagnosis can be made on clinical grounds alone.

    No single test can provide adequate information to support an MS diagnosis. Therefore, supportive and confirmatory paraclinical examinations — including analysis of lesions by MRI, of cerebrospinal fluid (CSF), and sometimes of evoked potentials — are still important in helping to confirm an MS diagnosis.

    What Has Changed: There is new emphasis that the McDonald Criteria should only be applied to those who present with a clinically isolated syndrome (CIS) suggestive of MS, or who have symptoms consistent with a central nervous system inflammatory demyelinating disease. The panel also considered how well the Criteria can be applied to specific populations such as childhood MS (paediatric MS) and Asian and Latin American populations. They concluded that the 2010 Revised Criteria would apply to the majority of these populations, but the paper describes specific situations in which further considerations and tests would be recommended to properly diagnose MS in these groups.

    In past versions of the McDonald Criteria, guidelines were presented for using MRI to demonstrate dissemination of disease in time and space, based on earlier studies. For the 2010 Revised Criteria, published recommendations from the European MAGNIMS multicenter collaboration have been incorporated (Swanton JK, Rovira A, Tintoré M, et al. Lancet Neurol 2007;6:677-686; Swanton JK Fernando K, Dalton CM, et al. J Neurol Neurosurg Psychiatry 2006;77:830-833.) These indicate that:

    Dissemination in time can be demonstrated by a new T2 or gadolinium-enhancing lesion on a follow-up MRI, with reference to a baseline scan, regardless of when the baseline MRI was obtained. (Previous versions had specified that the reference scan be performed at least 30 days after the initial clinical event; this is no longer a requirement.)

    Dissemination in space can be demonstrated with at least one T2 lesion in at least two our of four areas of the central nervous system: periventricular, juxtacortical, infratentorial, or spinal cord. These lesions need not be gadolinium enhanced.

    In the case of diagnosing primary-progressive MS, aspects of the previous criteria remain, but the MAGNIMS recommendations for demonstrating dissemination in space were incorporated to harmonize with other 2010 updates. As shown in Table 1, diagnosing primary-progressive MS requires one year of disease progression (determined retrospectively or prospectively), plus at least 2 out of these 3 criteria: dissemination in space in the brain based on at least 1 T2 lesion in periventricular, juxtacortical or infratentorial regions; dissemination in space in the spinal cord based on at least 2 T2 lesions; or positive cerebrospinal fluid (CSF) findings.

    While the International Panel has provided revised and simplified criteria for MS diagnosis, recommendations for further testing of the Criteria are made as well, to bolster the scientific evidence supporting the 2010 recommendations.

    Comment: The 2010 Revisions to the McDonald Diagnostic Criteria for MS should speed and make easier and more certain the diagnosis of MS. As with the original Criteria, these need prospective study, and it is expected that additional research will result in further refinements.

    “Efforts like the work of this international panel illustrate the National MS Society’s role as a convening force to push forward progress that not only improves clinical care, but also identifies research opportunities and gaps,” noted Timothy Coetzee, PhD, the Society’s chief research officer. “The paper highlights the need for research to identify additional biological markers of MS and its subtypes. This gap impedes progress on several fronts, making it an important target for our research efforts,” he continued.

    Full details are available in the free-access paper published in the February 2011 issue of Annals of Neurology (2011;69:292-302

    Source: Science Blog © 2011 Science Blog. (10/03/11)

    Further Information 

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