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
|
|
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
or a positive CSF and 2 or more MRI lesions consistent with MS
or further clinical attack involving different site
|
|
1 attack
2 or more objective clinical lesions
|
Dissemination in time, demonstrated by:
MRI
or second clinical attack
|
|
1 attack
1 objective clinical lesion
(monosymptomatic presentation)
|
Dissemination in space, demonstrated by:
MRI
or positive CSF and 2 or more MRI lesions consistent with MS
and
Dissemination in time demonstrated by:
MRI
or second clinical attack
|
|
Insidious neurological progression suggestive of MS
(primary progressive MS)
|
Positive CSF
and
Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion
and
Dissemination in time demonstrated by:
MRI
or continued progression for 1 year
|
Related Criteria
NIH Diagnostic Criteria for Neurofibromatosis
Diagnostic Criteria for Tuberous Sclerosis Complex (TSC)
Diagnostic Criteria for Neurocysticercosis
Diagnostic Criteria and
Associated Features of Restless
Legs Syndrome (RLS)
Diagnostic Criteria for
Parkinson’s Disease (PD)
More...
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]
