Meaning of Clinical Evidence in McDonald Criteria?

Hi Everyone,

I was reviewing the McDonald Criteria and it says something about "clinical evidence."
Would that mean, going to a neurologist office or an opthamologist office and having them see & examine your attack (symptoms) or is that something more objective, like an MRI?

Or can it mean either of these items - an office visit or an MRI?

Thank you,
Kelly

[Quixotic1]

Hi, Kelly, Jen is partly right.

The clinical picture or clinical setting or clinical history is made up of two parts.

The first part is what the patient reports.  This can be in the way of symptoms, what makes something worse or better.  It can be the answers the patient gives to the doctor's questions.  It is also the patient's medical history and family history.  With regard to MS this could be the pattern of symptoms (such a relapses), a family history of MS, or even the information that earlier doctors had suspected MS.

The second part of the clinical findings are what is found on the neurological and physical exam.  So if the doctor notes an ataxic gait, hyperreflexia, nystagmus or a pale optic disc.  In the context of MS these finding make up what the McDonald Criteria calls "clinical lesions".

Evidence of a brain or spine lesion can be found often in the exam, but as Jen said it may or may not be seen (visible) on the MRI.  The good doctor will be competent in his exam and confident of his clinical information.

So, historically MS has been a clinical diagnosis.  If the history provided enough data to see two or more relapses  AND the exam provided evidence of two neurological abnormalities (like I listed above) then MS can throretically be diagnosed IF the mimics have been ruled out.

Clinical = History and Physical Exam

Paraclinical = results of diagnostic testing like MRI, blood tests, LP results, VEP, etc.

Does this help?

Quix

[jensequitur]

Clinical evidence is what the doctor finds upon examination in a clinical setting.  A good neurologist can examine you and find evidence of lesions, even though the MRI may not show them.

[Quixotic1]

Hi, Kelly, Jen is partly right.

The clinical picture or clinical setting or clinical history is made up of two parts.

The first part is what the patient reports.  This can be in the way of symptoms, what makes something worse or better.  It can be the answers the patient gives to the doctor's questions.  It is also the patient's medical history and family history.  With regard to MS this could be the pattern of symptoms (such a relapses), a family history of MS, or even the information that earlier doctors had suspected MS.

The second part of the clinical findings are what is found on the neurological and physical exam.  So if the doctor notes an ataxic gait, hyperreflexia, nystagmus or a pale optic disc.  In the context of MS these finding make up what the McDonald Criteria calls "clinical lesions".

Evidence of a brain or spine lesion can be found often in the exam, but as Jen said it may or may not be seen (visible) on the MRI.  The good doctor will be competent in his exam and confident of his clinical information.

So, historically MS has been a clinical diagnosis.  If the history provided enough data to see two or more relapses  AND the exam provided evidence of two neurological abnormalities (like I listed above) then MS can throretically be diagnosed IF the mimics have been ruled out.

Clinical = History and Physical Exam

Paraclinical = results of diagnostic testing like MRI, blood tests, LP results, VEP, etc.

Does this help?

Quix

[kelly97]

Hi Quix,

Yes, that does help - your explanation seems pretty easy to understand. I think you may have been a neurologist in a past life. Although, with some of our experiences with them, I'm not sure how big of a compliment that is, so I may take it back. :-)

With how you explained it, I don't know why so many stay in limbo for so long. It seems to be pretty clear picture.

The countdown begins for my long awaited appt at the Rocky Mtn MS Center...it's a week from today.

Thanks for your thoughts, too, Jen. I appreciate it.

Kelly

[Lulu54]

Good luck at Rocky Mtn.  I read good things about their program but it will be nice to have a first hand report.  

Lu

[kelly97]

Hi,

I went today to the Rocky Mtn MS Ctr. You're right - from what I saw today, they are great. They're very professional and nice, and it really seems like they know what they're doing. The neurologists took about an hour discussing everything with me and personally looking at each of my MRI scans. My other neurologist never did that.
Plus, he really stressed the need to start taking DMDs. They seem very knowledgeable.  I just wish the drive wasn't so far (1 1/2 hours each way) - but it's worth it, if it's going to help me.

Thanks

[Lulu54]

Kelly,
Initially the drive seems long, but keep in mind once you get settled into the routine you probably won't be seeing the neuro more than twice a year.  

Many of us travel to see the right doc - my drive is also about 90 minutes each way - and feel it is well worth the effort.  I just find other things to do and make it a real road trip for the day.

We're happy to hear Rocky Mtn lived up to its reputation - we can use that one as a suggestion for folks out your way.

Good luck with making the DMD decision and getting it started  - it's the best thing to do.

-L