Diagnosing Multiple Sclerosis (MS)

There are no laboratory tests, symptoms, or physical findings that can, by themselves, determine if a person has multiple sclerosis. Furthermore, there are many symptoms of MS that can also be caused by other diseases. Therefore, the MS diagnosis can only be made by carefully ruling out all other possibilities.

The long-established criteria for diagnosing MS are:

1. There must be objective evidence of two attacks (i.e. two episodes of demyelination in the central nervous system). An attack, also known as an exacerbation, flare, or relapse, is defined clinically as the sudden appearance or worsening of an MS symptom or symptoms, which lasts at least 24 hours. The objective evidence comes from findings on the neurologic exam and additional tests.

2. The two attacks must be separated in time (by at least one month) and space (indicated by evidence of inflammation and/or damage in different areas of the central nervous system).

3. There must be no other explanation for these attacks or the symptoms the person is experiencing.

Over the last twenty years, tests such as magnetic resonance imaging, examination of cerebrospinal fluid, and evoked response testing have played an increasingly important role in the diagnostic process. In 2001, the International Panel on the Diagnosis of Multiple Sclerosis, chaired by W.I. McDonald, FRCP (Royal College of Physicians, London), issued a revised set of diagnostic criteria (Annals of Neurology 2001; 50:121-127).

Since 2001, the McDonald Criteria for Diagnosis of MS have been used worldwide. The International Panel, chaired by Chris Polman, MD, reconvened in March 2005 to consider extensive data that had been collected since 2001 and to recommend appropriate revisions to the criteria. These revisions, termed the 2005 Revisions to the McDonald Diagnostic Criteria for MS, were published in 2005 ( Annals of Neurology 2005; 58:840-846). These revisions will help to enhance the speed and accuracy of an MS diagnosis.

MRI Is the Preferred Method of Imaging the Brain

MRI (magnetic resonance imaging) is the preferred method of imaging the brain to detect the presence of plaques or scarring caused by MS. This technology is able to detect lesions in different parts of the central nervous system and differentiate old lesions from those that are new or active.

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An international panel of neurologists has updated the current guidelines for diagnosing multiple sclerosis (MS), strengthening the role of magnetic resonance imaging (MRI). The guidelines, published online November 10, 2005 in the Annals of Neurology, update the "McDonald criteria," created 5 years ago and named after the chair of the previous panel, Prof W. Ian McDonald of the Institute of Neurology in London. Learn more about the role of MRI in MS

"We hope, and trust, that these revisions will allow an even earlier diagnosis of MS, without any loss of diagnostic accuracy," said Chris H. Polman, MD, of the Free University Medical Center in Amsterdam, The Netherlands, and chair of the current panel.

"The changes in diagnostic criteria for primary progressive multiple sclerosis is particularly helpful," said Robert P. Lisak, MD, of Wayne State University in Detroit, Michigan, and chair of the American Neurological Association's public information committee. "The ability to make the diagnosis of multiple sclerosis early and accurately is important for both patient care and for clinical research including clinical trials of new treatments."

There is increasing evidence that MS drugs such as interferon beta and glatiramer acetate are most effective when started early in the disease course.

The original McDonald Criteria were the first to incorporate MRI testing into the traditional tool kit of neurological history and examination, along with various laboratory exams. Brain imaging can show physicians the damaged sites (termed 'lesions') in the brain and spinal cord.

"A series of studies performed during the last few years, with improved techniques for spinal cord MRI, shows that it is a powerful tool not only to demonstrate MS lesions, but also to exclude alternative diagnoses," said Dr. Polman.

The new criteria also conclude that only two separate MRI scans, rather than three, are needed to evaluate whether the disease is progressing.
Learn more about the role of MRI in MS

REFERENCE:

Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the 'McDonald Criteria. Annals of Neurology; Published Online: November 10, 2005 (DOI: 10.1002/ana.20673).

SOURCE: John Wiley & Sons, Inc.