I wanted to post the criteria for MS diagnosis. Many have questioned why they have not been diagnosed without positive MRI results, but positive, or O-bands in their CSF.
I was diagnosed in 2004 after a long time in limbo and know the frustrations you all are going through. It was hard for me as a healthcare provider to accept these guidelines, but they are there to protect us against misdiagnosis and wrongful treatment. Here they are:
1. Clinical Presentation
* 2 or more attacks (relapses)
* 2 or more objective clinical lesions
Additional Data Needed:
None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
2. Clinical Presentation:
* 2 or more attacks
* 1 objective clinical lesion
Additional Data Needed:
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
3. Clinical Presentation:
* 1 attack
* 2 or more objective clinical lesions
Additional Data Needed:
Dissemination in time, demonstrated by:
* MRI
* or second clinical attack
4. Clinical Presentation:
* 1 attack
* 1 objective clinical lesion
(monosymptomatic presentation)
Additional Information Needed:
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
5. Clinical Presentation:
Insidious neurological progression
suggestive of MS
(primary progressive MS)
Additional information needed:
One year of disease progression (retrospectively or prospectively determined) and
Two of the following:
a. Positive brain MRI (nine T2 lesions or four or more T2 lesions with positive VEP)
b. Positive spinal cord MRI (two focal T2 lesions)
c. Positive CSF
When a patient has positive CSF that has specific markers for MS (like meylin basic protein increase, IgG increases, and >3 O-bands with all of these), evoked potentials can be used at times to check for "lesion" evidence if MRIs continue to be negative within the first year.
After the first year, physicians begin to doubt the diagnosis if the MRI remains negative. Sometimes a more in-depth 3T MRI can be done (normal MRs are 1.5), to check for small lesions, but most MS lesions are large enough to be seen on a 1.5.
If your O-bands disappear, it is not MS. O-bands do not disappear in MS, nor to spinal lesions. Brain lesions can, but leave behind a "black hole".
An MRI that has white matter lesions will sometimes be non-specific and not qualify for diagnosis of MS. MS has a specific pattern and look. Your neurologist is trained to look for this pattern as are radiologists.
I was diagnosed in 2004 after a long time in limbo and know the frustrations you all are going through. It was hard for me as a healthcare provider to accept these guidelines, but they are there to protect us against misdiagnosis and wrongful treatment. Here they are:
1. Clinical Presentation
* 2 or more attacks (relapses)
* 2 or more objective clinical lesions
Additional Data Needed:
None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
2. Clinical Presentation:
* 2 or more attacks
* 1 objective clinical lesion
Additional Data Needed:
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
3. Clinical Presentation:
* 1 attack
* 2 or more objective clinical lesions
Additional Data Needed:
Dissemination in time, demonstrated by:
* MRI
* or second clinical attack
4. Clinical Presentation:
* 1 attack
* 1 objective clinical lesion
(monosymptomatic presentation)
Additional Information Needed:
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
5. Clinical Presentation:
Insidious neurological progression
suggestive of MS
(primary progressive MS)
Additional information needed:
One year of disease progression (retrospectively or prospectively determined) and
Two of the following:
a. Positive brain MRI (nine T2 lesions or four or more T2 lesions with positive VEP)
b. Positive spinal cord MRI (two focal T2 lesions)
c. Positive CSF
When a patient has positive CSF that has specific markers for MS (like meylin basic protein increase, IgG increases, and >3 O-bands with all of these), evoked potentials can be used at times to check for "lesion" evidence if MRIs continue to be negative within the first year.
After the first year, physicians begin to doubt the diagnosis if the MRI remains negative. Sometimes a more in-depth 3T MRI can be done (normal MRs are 1.5), to check for small lesions, but most MS lesions are large enough to be seen on a 1.5.
If your O-bands disappear, it is not MS. O-bands do not disappear in MS, nor to spinal lesions. Brain lesions can, but leave behind a "black hole".
An MRI that has white matter lesions will sometimes be non-specific and not qualify for diagnosis of MS. MS has a specific pattern and look. Your neurologist is trained to look for this pattern as are radiologists.
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