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Diagnostic criteria question

Hi.  Does anyone know whether fatigue counts as one of the two "episodes/attacks" required for an MS diagnosis? I'm talking of very specific and debilitating fatigue that makes any effort -- even just taking a shower -- so difficult that I can hardly do anything all day but sleep. I've been battling that for a couple of years, and one neurologist described it as being "MS-fatigue" in its make-up and intensity, but at that point I hadn't had any other episodes. Now I am having an attack of severe optic neuritis. I will be seeing an MS specialist in a few weeks (torture to wait for the appointment), and I'm wondering if the fatigue and ON would meet the criteria for two separate attacks. (Obviously I know no-one can diagnose online, I'm just anxious as I wait and wait for the appointment, and I'm playing things out in my head.)

In summary:  my specific question is whether "fatigue" is considered an episode/attack for diagnostic purposes -- or whether it's considered a secondary symptom, not one to be considered to meet the diagnostic criteria (as, for instance, optic neuritis, trouble walking, etc. would be).

Thanks for any insights.
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667078 tn?1316000935
That is a good question. Since MS ia a diagnosis of excluding all other possibilities and many other illnesses have fatigue it is really up to the MS Specialist. I had many MS symptoms all my life but until I had positive MRIs for two years and a very positive LP, positive VEP and BAER and negative blood work for everything else no Doctor would diagnose it as MS. They all said I would be diagnosed as MS in the future. It can be frustrating.

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1448748 tn?1312956208
I'm not sure either, but since we are on the subject,i don't write understand the criteria anyways. It says you have to have two episodes or attacks, what sites that mean exactly? Doesn't it also say it had to be separated by at least 30 days? So what about ppms? Doesn't that just get progressively worse without breaks or specific attacks?  So that leaves me confused, you can't get a diagnosis if yours is the progressive and once you got symptoms they never stopped, they only got worse?
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1318483 tn?1318347182

Our Health Pages have some really great articles on signs vs. symptoms, the anatomy of a flare, even fatigue.  Here is a direct link to the Health Pages:


You can always access these anytime you want through the link in the top right hand corner, too.

Hope this helps,
Helpful - 0
1453990 tn?1329231426
Some stuff changes with the 2010 revision of the McDonald Criteria.  The new Criteria is available here: http://onlinelibrary.wiley.com/doi/10.1002/ana.22366/pdf

The "new" criteria defines an attack as:

"An attack (relapse; exacerbation) is defined as patient-reported or objectively observed events typical of an acute inflammatory demyelinating event in the CNS, current or historical, with duration of at least 24 hours, in the absence of fever or infection. It should be documented by contemporaneous neurological examination, but some historical events with symptoms and evolution characteristic for MS, but for which no objective neurological findings are documented, can provide reasonable evidence of a prior demyelinating event. Reports of paroxysmal symptoms (historical or current) should, however, consist of multiple episodes occurring over not less than 24 hours. Before a definite diagnosis of MS can be made, at least 1 attack must be corroborated by findings on neurological examination, visual evoked potential response in patients reporting prior visual disturbance, or MRI consistent
with demyelination in the area of the CNS implicated in the historical report of neurological symptoms."

I don't think that "fatigue" would rise to the level of "characteristic of a demyelinating event.

Helpful - 0
1318483 tn?1318347182

Thanks for that link, Bob.  I have been waiting to get a link on the new criteria.  :)

Scamper - when you went to see the neuro who called it MS Fatigue, were you having any other symptoms?  Did he do a complete neuro exam on you?  If so, what were the results?  Maybe you have a different sign other than fatigue that could have been your first attack?

Are you going to see that same neuro that you saw for the fatigue?  Are you being treated for the ON?

Just some things I wondered...
Helpful - 0
1253197 tn?1331209110
This is a really interesting question as for me the fatigue episodes that I have had (one of which was described as a relapse) have been far more debilitating than the small numb finger that I had that was also described as a relapse as it was a new symptom and lasted for several months.

I am sure that Bob's explanation and the link make this clear and that the fatigue is almost certainly as a result of some demyelinating activity/event but it is not always clearcut for all of us.

Cheers Sarah
Helpful - 0
198419 tn?1360242356
Hi there,

Thanks for joining!

While they may not be able to confirm a demyelinating event from fatigue alone (because it can be chronic and associated w/many issues), fatigue definitely can and does happen during an attack where MS is concerned.  There is a clear distinction between tired and fatigue.  If you are dx'd w/ON, this would further support an attack. I'd say it's one in the same and a true event.

As a general rule, definitely tell the specialist, but know an MS specialist will know what this is regardless of how the guidelines fluctuate in their use of language from year to year. These guidelines are not followed so closely as to change up a specialist's ability to identify attacks.

Welcome  - welcome, feel free to ask anything!

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