Multiple Sclerosis

Electroencephalography and Clinical Neurophysiology, 1989

We prospectively examined 58 patients with suspected or confirmed multiple sclerosis (MS) to evaluate the impact of paraclinical studies (evoked potentials (EPs) and magnetic resonance imaging (MRI)) in the diagnostic evaluation of these patients. All patients had cranial MRI studies, brain-stem auditory (BAEP), visual (VEP), posterior tibial (PTN-SSEP) and median somatosensory (MN-SSEP) EPs. Patients were categorized according to criteria of Poser et al. initially without knowledge of paraclinical studies. On the basis of clinical history, neurological examination and CSF chemical analysis, there were 18 (31%) clinically definite (CD), 10 (17%) laboratory supported definite (LSD), 13 (22%) clinically probable (CP) MS cases; 17 (29%) cases could not be classified. By providing electrophysiological and/or anatomical evidence for a 'second lesion,' paraclinical studies permitted 25 patients to move from one diagnostic category to another, reflecting an increased certitude of the diagnosis. Twelve moved to CDMS by either MRI or one EP study. Four moved to CDMS on the basis of MRI only, and four moved to CDMS by VEP only. Five moved from an unclassified status to either LSDMS or CPMS by PTN-SSEP (2), by PTN-SSEP or MRI (1), by MRI or VEP (1) and by VEP only (1). Thus, the diagnosis of MS was refined in 28% of the patients (7/25) by incorporation of EPs alone whereas cranial MILl by itself increased the diagnostic certainty in only 16% (4/25). In the remaining 56%, the diagnosis was refined by use of either EPs or MRI. Overall, EP provided evidence for a 'second lesion' in 36% of the patients (21/58) and MRI 31% (18/58). While MRI may ultimately prove the single most useful paraclinical study in the diagnosis of MS, VEPs, and PTN-SSEPs by assessing areas currently not imaged by MRI, remain essential in patient evaluation. Changes in EPs and MRI technology will undoubtedly redefine the role of these diagnostic techniques.

Background-ugu tu d'E te, the g d o of E g d' Ki g Geo ge III, i now thought to have MS based on a diary he kept until his death in 1848, in which he described symptoms that sound much like MS, including blurred vision, weakness and numbness in his limbs, tremors and nocturnal spasms. Twenty years fte d'E te' de th, the P i i eu o ogi t Je-Martin Charcot was the first to identify and name MS. A fem e p tie t of Ch cot' was suffered from tremors, slurred speech and abnormal eye movements. He attempted to treat her, but with o v i. fte he de th, Ch cot ex mi ed the p tie t' b i d di cove ed the telltale plaques of MS the hardened scar tissue around nerve fibers. He was concerned with the discovery of MS. Aim of the work: multiple sclerosis is considered as one of the great imitators as it features various nonspecific symptoms such as sensory loss, spinal cord symptoms (Motor and autonomic), cerebellar symptoms, eye symptoms, optic neuritis, trigeminal neuralgia, psychiatric as well as constitutional symptoms and may be confused with a number of other diseases. In this project we aimed to identify problems and mistakes for diagnosis of MS in order to achieve early diagnosis and prevention of misdiagnosis and advancement of the disease. Patients and Methods: we have collected data about cases of multiple sclerosis disease from two major hospitals in Saudi Arabia (Saudi German Hospital, Madinah, Dammam Medical Complex, Dammam) during the year 2017. Among these cases we found 4 cases misdiagnosed as multiple sclerosis. The first case 48 years old female diagnosed with multiple sclerosis and treated with Imuran for 8 month with no benefit then patient came again with the same symptoms and MRI done for him with no change in MRI findings, thus the patient condition was not fit for the diagnostic criteria of multiple sclerosis and diagnosed as primary lateral sclerosis. Second case 37 years old patient came with acute onset paraplegia and diagnosed as transverse myelitis then came after 4 months; the patient developed symptoms of optic neuritis. The third case 42 years old female came with left sided hemiplegia and diagnosed as ischemic stroke and treated with vascular therapy without benefit then came again after 6 months with right sided hemiplegia and incoordination then diagnosed as multiple sclerosis. Fourth case 30 years old female came with acute diminution of vision and diagnosed as optic neuritis and treated without benefit then patient came again with the same presentation and diagnosed as clinically isolated syndrome. Results: MRI findings are not enough in diagnosis of multiple sclerosis and should be accompanied by good clinical expertise; lab tests as well as exclusion of any other condition could be misdiagnosed as multiple sclerosis. Conclusion: multiple sclerosis (MS) is an immune-mediated inflammatory disease that attacks myelinated axons in the central nervous system, destroying the myelin and the axon in variable degrees and producing significant physical disability within 20-25 years in more than 30% of patients. The hallmark of MS is symptomatic episodes that occur months or years apart and affect different anatomic locations.

Acta Neurologica Scandinavica, 2005

Journal of Neurology, 1993

The sensitivities and predictive values of visual, somatosensory, and brain auditory evoked potentials (EPs), cerebrospinal fluid oligoclonal banding (CSF-OB) and magnetic resonance imaging (MRI) were evaluated for the early diagnosis of clinically definite multiple sclerosis (CDMS). Paraclinical evidence of asymptomatic lesions allows a diagnosis of CDMS. Eightytwo patients in whom MS was suspected but diagnosis of CDMS was not possible entered the study prospectively. Paraclinical examinations were performed at entry. Patients were examined and underwent EPs every 6 months, and MRI yearly. After a mean follow-up of 2.9 years, 28 patients (34%) had developed CDMS (McDonald-Halliday criteria).

Archives of Neurology, 2005

Background: Intrathecal IgG synthesis (ITGS), in conjunction with magnetic resonance imaging, can help in the early diagnosis of multiple sclerosis (MS). Recently, we developed a new oligoclonal IgG band (OCGB) test for ITGS detection that is more sensitive and easier to interpret than previously described methods.

Neurologic Clinics, 2006

Frontiers in Neurology

Frontiers in Immunology

Annals of Neurology, 2001

The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsingremitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."

Journal of Neurology, Neurosurgery & Psychiatry, 1995

The yield of paraclinical tests was evaluated in a prospective study of 189 consecutive patients referred for suspected multiple sclerosis (142 patients with multiple sclerosis, 47 non-multiple sclerosis patients on discharge). Patients were first classified according to the Poser criteria by the clinical findings. Subsequently, the results of paraclinical tests (cranial MRI, visually evoked potentials (VEPs), somatosensory evoked potentials by tibial nerve stimulation (SSEPs), motor evoked potentials (MEPs), and analysis of CSF for oligoclonal banding and IgG-index (CSF)) were taken into account. The percentage of reclassified patients (reclassification sensitivity, RS) was always lower than the percentage of abnormal results (diagnostic sensitivity, DS), and the divergence of RS v DS differed between the tests (60% v 84% in MRI, 31% v 77% in CSF, 29% v 37% in VEPs, 20% v 68% in MEPs, and 12% v 46% in SSEPs respectively). False reclassifications of nonmultiple sclerosis patients to multiple sclerosis would have occurred with all tests (MRI: six of 47 patients, (reclassification specificity 88%); CSF: one (98%); VEPs: two (96%); MEPs: two (96%); SSEPs: four (91%); P < 0-05). Although MRI had superior diagnostic capacity, 57 of the 142 patients with multiple sclerosis were not reclassified by the MRI result, 12 of whom were reclassified by CSF and 18 by one of the evoked potential (EP) studies. Of the 98 patients not reclassified by CSF, 53 were reclassified by MRI and 39 by EPs. The results suggest that for the evaluation of paraclinical tests in suspected multiple sclerosis, comparison of diagnostic sensitivities is inappropriate. In general, a cranial MRI contributes most to the diagnosis; however, due to its comparatively low specificity and its considerable number of negative results, EP or CSF studies are often useful to establish the diagnosis of multiple sclerosis.

Multiple Sclerosis Journal, 2008

Background and objectives Diagnosis of multiple sclerosis (MS) requires exclusion of diseases that could better explain the clinical and paraclinical findings. A systematic process for exclusion of alternative diagnoses has not been defined. An International Panel of MS experts developed consensus perspectives on MS differential diagnosis. Methods Using available literature and consensus, we developed guidelines for MS differential diagnosis, focusing on exclusion of potential MS mimics, diagnosis of common initial isolated clinical syndromes, and differentiating between MS and non-MS idiopathic inflammatory demyelinating diseases. Results We present recommendations for 1) clinical and paraclinical red flags suggesting alternative diagnoses to MS; 2) more precise definition of “clinically isolated syndromes” (CIS), often the first presentations of MS or its alternatives; 3) algorithms for diagnosis of three common CISs related to MS in the optic nerves, brainstem, and spinal cord; a...

Acta Neurologica Scandinavica, 2004

Journal of Neurology, Neurosurgery & Psychiatry, 2009

Objective: Recent studies reported contrasting results with respect to the presence of anti-myelin protein antibodies in multiple sclerosis (MS) and their relation with disease activity. This may be due to the heterogeneous specificity of autoantibodies in MS and the inability of most methods to detect pathogenically relevant antibodies. Here, myelin particles were used to detect anti-myelin antibodies in the CSF of MS patients. Subsequently, their relation with MRI parameters was evaluated. Methods: Anti-myelin IgG antibody reactivity was determined in the CSF of patients with MS (n = 65) and clinically isolated syndrome (CIS, n = 37) using a novel flow cytometry based assay. In addition, the CSF of patients with other neurological diseases (OND, n = 17), inflammatory neurological diseases (IND, n = 33) and controls (n = 22) was tested. Results: Compared with controls, increased anti-myelin IgG antibody reactivity was most frequently found in the CSF of patients with CIS (46%, p = 0.002), relapsingremitting MS (56%, p,0.001) and secondary progressive MS (55%, p,0.001), together constituting 85% of all positive CSF samples. In contrast, elevated anti-myelin IgG antibody reactivity was present in a minority of IND patients (21%), marginally present in controls (5%) and absent in OND patients (0%). Most strikingly, anti-myelin IgG antibody reactivity was related to the number of T2 lesions (r = 0.31, p = 0.041) and gadolinium enhancing T1 lesions (r = 0.37, p = 0.016) on brain MRI in CIS and relapse onset MS patients. Conclusion: CSF anti-myelin IgG antibodies are promising specific biomarkers in CIS and relapse onset MS and correlate with MR measures of disease activity.

Aim: of this study was to evaluate incidence, prevalence, the most frequent first symptoms of the patients with multiple sclerosis (MS) in Tuzla-canton (Bosnia and Herzegovina), then forms of disease and time that passed from first symptom at disease onset until diagnose verification. Patients and Methods: The area of the Tuzla-canton (TC) is 2649 km 2. According to the last census done in 2013 in the area it was registered 477278 inhabitants. In this study it was analyzed medical records of hospitalized patients as well as records during follow-ups. Results: The number of analyzed MS patients in TC is 243. Average age of patients at the moment of diagnose verification was 35.1 (SD ±10.8) and it was more women (178; 73.2%). Disease prevalence on December 31, 2013 is 50.4/100000. Incidence for 2013 is 2.5/100000. The most frequent is relapsing-remitting form of MS (207; 85.1%), then secondary-progressive (30; 12.4%) and the list frequent is primary-progressive (6; 2.5%). From the fir...

European Journal of Neurology, 2004

The aim of our study was to analyse clinical and paraclinical characteristics of patients with multiple sclerosis (MS) with previous diagnosis of primary-progressive (PP) MS according to the Poser's criteria and further investigate if they fulfil the McDonald's diagnostic criteria for this disorder. A total of 561 MS patients were registered in the database at the Institute of Neurology, Belgrade, from 1 January 1997 to 31 December 2000 and 63 of them (11.2%) with previous diagnosis of PPMS were analysed retrospectively. Male/female ratio was 1.3:1 and mean age at onset 33.2 years. Most frequent at onset were pyramidal (in 73% of patients) and sensory symptoms (in 41% of patients); 74.6% of patients had greater than or equal to nine brain magnetic resonance imaging (MRI) lesions. Intrathecal oligoclonal immunoglobulin G (IgG) was detected in 96.7% and prolonged visual evoked potentials (VEP) P100 latency in 82.4% of patients. Of the total study group of 561 patients, 10.2% fulfilled the recently recommended McDonald's diagnostic criteria for the diagnosis of PPMS. Our findings further support the significance of the brain/spinal cord MRI, cerebrospinal fluid and VEP findings for precise diagnostic assessment in patients with suspected PP form of MS.