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Multiple Sclerosis Message Board

Multiple Sclerosis Board Index

The question of whether or not there must be a lesion present to get a diagnosis is probably one of the most frequently asked questions. Perhaps my following summary of information will help you decide.

Basically, in April, 2001, an international panel in association with the NMSS of America recommended revised diagnostic criteria for multiple sclerosis. Many doctors are trying to adhere to the current diagnostic criteria, but others still haven't caught up or have chosen not to follow this recommendation. These new criteria have become known as the McDonald criteria (named after their lead author). They make use of advances in MRI imaging techniques and are intended to replace the Poser Criteria and the older Schumacher Criteria.

I've listed the criteria below. The bold words are the clinical presention, and the italics are what is needed in addition to the clinical presentation in order to get an MS diagnosis.

[B]Clinical Presentation[/B] - [I]Additional Data Needed [/I]

[B]2 or more attacks (relapses)
2 or more objective clinical lesions [/B]
[I]None; clinical evidence will suffice
(additional evidence desirable but must be consistent with MS) [/I]

[B]2 or more attacks
1 objective clinical lesion [/B]
[I]Dissemination in space, demonstrated by:
[U]or[/U] a positive CSF and 2 or more MRI lesions consistent with MS
[U]or[/U] further clinical attack involving different site [/I]

[B]1 attack
2 or more objective clinical lesions [/B]
[I]Dissemination in time, demonstrated by:
[U]or[/U] second clinical attack [/I]

[B]1 attack
1 objective clinical lesion
(monosymptomatic presentation) [/B]
[I]Dissemination in space by demonstrated by:
[U]or[/U] positive CSF and 2 or more MRI lesions consistent with MS
Dissemination in time demonstrated by:
second clinical attack [/I]

[B]Insidious neurological progression
suggestive of MS
(primary progressive MS)[/B]
[I]Positive CSF
Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion
Dissemination in time demonstrated by:
or continued progression for 1 year [/I]

So, depending on your presentation, if your doctor is using this diagnostic criteria, he'll need to see a minimum of one additional lesion (two total).

I hope this distillation of information helps answer some of your questions, but more importantly - I hope you don't have MS!!

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