Tuesday, 28 February 2012

Education: Diagnosis of MS

Polman CH et al. Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria. Anal Neurol 68:292-302

New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.
Diagnostic criteria for multiple sclerosis (MS) include clinical and paraclinical laboratory assessments emphasizing the need to demonstrate dissemination of lesions in space (DIS) and time (DIT) and to exclude alternative diagnoses. Although the diagnosis can be made on clinical grounds alone, magnetic resonance imaging (MRI) of the central nervous system (CNS) can support, supplement, or even replace some clinical criteria, as most recently emphasized by the so-called McDonald Criteria of the International Panel on Diagnosis of MS. The McDonald Criteria have resulted in earlier diagnosis of MS with a high degree of both specificity and sensitivity, allowing for better counseling of patients and earlier treatment.

Since the revision of the McDonald Criteria in 2005, new data and consensus have pointed to the need for their simplification to improve their comprehension and utility and for evaluating their appropriateness in populations that differ from the largely Western Caucasian adult populations from which the Criteria were derived. In May 2010 in Dublin, Ireland, the International Panel on Diagnosis of MS (the Panel) met for a third time to examine requirements for demonstrating DIS and DIT and to focus on application of the McDonald Criteria in pediatric, Asian, and Latin American populations.


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