Diagnostic criteria for multiple sclerosis

Clinical Neurology and Neurosurgery
C M Poser, Vesna V Brinar

Abstract

Over a hundred years ago, Charcot set down what he considered to be some of the clinical characteristics of multiple sclerosis (MS). His triad was not specific but it was the first attempt to separate this disease from the many others affecting the nervous system. The history of clinical diagnostic criteria demonstrates the evolution from rather tentative classifications of restricted value to the more elaborate 1983 scheme which incorporates some laboratory procedures under the rubric paraclinical tests, considered to be extensions of the neurological examination, as well as a new category based on the presence of specific abnormalities of the cerebrospinal fluid (CSF). It is curious that until then the term definite MS had been avoided except for autopsy-proven cases, perhaps a wise move, since exact diagnosis may require long term observation. All the proposed schemes have been based on the twin principles of dissemination in both time and space. The diagnosis of MS must remain a clinical one, supported but not supplanted by the increasingly popular magnetic resonance imaging, which is non-specific and is frequently overinterpreted by radiologists lacking appropriate clinical information. Reliance on the MRI as the principal...Continue Reading

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