Re: MS diagnosis

Posted By CCF Neurology MD on September 27, 1997 at 23:26:49:

In Reply to: MS diagnosis posted by Michelle Mullee on September 25, 1997 at 15:56:25:







: I was recently diagnosed with MS. The neurologist diagnosed this on clinical exam as well as history. I had a negative MRI as well as a normal VER. Is it common to diagnose based only on clinical symptoms, exam, and history? Also if you are not having a flare up at the time of a spinal tap will it still indicate MS? I have also read a lot about MS and find conflicting terminology, one neurology book defines remitting-recurring and benign as two different types while another defines them as the same?




Dear Michelle:
1) MS can be definitively diagnosed without any tests, that is, with only a history and a physical examination. All that the diagnosis requires is typical lesions (clinical deficits such as optic neuritis, myelitis, brainstem affection, and others) occuring in atleast two different sites at different times in the course of the illness, provided that other causes are excluded. In fact, MS has been diagnosed, classically speaking, for several decades using this general concept of dissemination of lesions in space and time. The role of the MRI in modern times is two-fold. Firstly, typical lesions on MRI help confirm the clinical diagnosis of MS in more than 90% of cases. Secondly, and more importantly, MRIs help exclude other disorders that may mimic MS.
2) A negative MRI (and a negative VEP) do not rule out the diagnosis of MS, if appropriately diagnosed otherwise. They are, however, a "red flag" cautioning the neurologist about the possibility of another diagnosis.
3) The spinal fluid (CSF) usually continues to show characteristic abnormalities (oligoclonal bands, elevated intrathecal IgG synthesis rate) between flare-ups. A cellular response is usually noted only at the time of flare-ups.
4) There are three major classes of MS disease course a) Relapsing (or relapsing-remitting) - 85 to 90 percent of cases start out this way. b) Secondarily progressive - about half of patients with the relapsing type later in their course begin getting steadily increasing deficit without clear-cut relapses/remissions. c) Primarily progresive - about 10-15% of cases start out with steady deterioration without clear remissions. "Benign" MS is generally meant to mean some patients of the relapsing-remitting type who do not accumulate significant chronic deficit or disability even after several years (or a few decades) of disease. These patients usually have infrequent relapses.
I hope this answers your questions. In case you live near Cleveland, any of the neurologists at the Mellen Center for MS (an institution affiliated to the Cleveland Clinic dedicated to MS research and patient care) would be glad to answer any further concerns or questions that you may have. Dr. Rudick, Dr. Ransohoff, Dr. Cohen, and Dr. Kinkel are nationally renowned for their contributions to this field. The number to call for appointments is [phone], or [phone].