Help with Revised McDonald Criteria

[Snickers78]

I'm not trying to be annoying. I am trying to make sense of things and to fully understand my medical situation, lack of diagnosis at this point, whether my MS Specialist and Neurologist are correct in their statements, etc.

I was reviewing the McDonald Criteria and read the part: "Excludes pseudoattacks, single paroxysmal symptoms (multiple episodes of paroxysmal symptoms occurring over 24 hours or more are acceptable as evidence)"

I don't have any symptoms that last consistently for 24 hours. I have lots of symptoms that come and go for days: numbness that goes from left hands to right hands, different fingers, legs, feet, etc. One moment, fingers on my left hand feel numb. A few hours later, my right foot feels numb. The symptoms are all over the place throughout the day with some days having very little or nothing.

Do my symptoms fall into this category? I am very confused.

Thank you.

[minnie76]

Hi,

Not an expert, but from what I've been told, 24hours is how long your finger, hand or foot would need to be numb.
I too have that sometimes, but it needs to be consistent in the same spot.

So when the tingling in my face lasted more then 24hrs (over a week in a spot near my nose) I called the neuro back. Was diagnosed with TN.

I have little zings here and there all over body and face...but neuro told me it had to last.

So when my arm falls asleep...it needs to remain numb for 24hrs is what I was told.

Hope that helps.

I'm still in limbo

Minnie76

[MSer102]

Hi Snickers: The passage you quoted applies to a person's self report of symptoms as evidence of an attack. Before that part is the definition of an attack.

"An attack (relapse; exacerbation) is defined as patient-reported or objectively observed events typical of an acute inflammatory demyelinating event in the CNS [central nervous system], current or historical, with duration of at least 24 hours, in the absence of fever or infection." Numbness that moves to different spots all over your body over 24 hours is not typical of an acute inflammatory demyelinating event in the central nervous system so it doesn't fit that category.

More important than that are the other criteria that have to be met for a diagnosis of MS and it sounds like you don't meet any of them.

The other thing about a diagnosis of MS is that every other condition that can cause the same symptoms has to be ruled out or accounted for. So it sounds like it's time to work with your GP to make sure those other conditions that can cause numbness have all been tested for.

[Cat Mom]

A stupid question... please forgive me! Is the MsDonald Criteria more of a measurement of the level of disability rather than being used to make a diagnosis? Or both?

Thanks in advance,
Jen

[Mamabug]

www.nationalmssociety.org/DxTipsheet

As I understand it, Cat, it is only diagnostic criteria. It is possible to have no disability, but only to have symptoms of an attack combined with clinical evidence. Symptoms of MS often go into remission following an attack and leave no residual disability.

~ Faith

[Alicious]

Faith is right, is is simply the criteria used for diagnosis. I have an EDSS of 0, but based on past history of flares and MRIs that light up like a Christmas tree, meet the criteria for diagnosis.

Snickers, I agree with the others as regards the 24 hour benchmark. Clearly *something* is going on with your body, and I hope they can figure it out.

[pyablon]

Understand your frustration...

I understand the the McDonald Criterior has been revised to make it easier to make a diagnosis. My question, is one lesion in the pons and hyperreflexia enough to give a definitive diagnosis of PPMS?

I have been told that I have probably had MS for 10 years but all of my tests (blood,EVP, LP, cytology) are normal or negative. Shouldn't something have come back positive??

And, my MS doc wants me to see an ID doc which I will do at the end of October. Only adds to my confusion!

[MSer102]

My question, is one lesion in the pons and hyperreflexia enough to give a definitive diagnosis of PPMS?

It doesn't sound like it.

The criteria say that you have to have two of the criteria given under part 2 for PPMS. It sounds like you only have one of them. You have one infratentorial lesion (in your pons and I'm assuming it's a T2 lesion). But you must also have either two T2 lesions in your spinal cord or a positive LP. Your said your LP was normal so that's out. And you don't have any spinal cord lesions so that's out too.

Hyperreflexia suggests some kind of spinal cord injury but it isn't specific. The criterion is spinal cord lesions not just a sign/symptom like hyperreflexia. I think there are probably doctors who would diagnose MS based on hyperreflexia if no other cause for the hyperreflexia could be found. But it wouldn't be the "easy" diagnosis that the McDonald criteria allows.

I have been told that I have probably had MS for 10 years

The first criterion for PPMS is 1 year of progression not just the presence of MS. You may have had MS for 10 years but did you have progression over the course of a year?

all of my tests (blood,EVP, LP, cytology) are normal or negative. Shouldn't something have come back positive??

No not necessarily. There are currently no blood tests for MS so blood test results don't directly count. They only help to rule out other conditions.

A VEP will be positive only if there is demyelination in the visual part of the brain. If the demyelination is somewhere else it won't show up on a VEP. If you break your foot it won't show up on an Xray of your hand.

At least 10% (and I've seen some estimates that are higher) of people who are diagnosed with MS based on other evidence have normal LP's. (My LP was normal.) It doesn't have to be positive. That's just the way it is. Since your LP was negative it can't be used to help you meet the diagnostic criteria for PPMS.

Is that why your neurologist sent you to an infectious disease specialist? To look for other causes of the hyperreflexia?

[javaaddict]

I understand the the McDonald Criterior has been revised to make it easier to make a diagnosis. My question, is one lesion in the pons and hyperreflexia enough to give a definitive diagnosis of PPMS?

Here is how this has been explained to me:

With McDonalds you have to meet 2 requirements - episodes separated by time (more than a month between) and space (lesions present on brain AND ON AND/OR spine - so 2 out of 3). That's the super down and dirty on it. One episode is not enough. One lesion is not enough, even if the lesion does not correlate to the current episode.

The best I can tell you is that dxing MS is not like much of anything else. It's a long process, where data is collected over time.

Best of luck to you.