The diagnosis of multiple sclerosis and the clinical subtypes

Departments of Medicine, Neurology, and Community and Family Practice, Duke University Medical Center, Box 3184 DUMC, Durham, NC 27710, USA.
Annals of Indian Academy of Neurology (Impact Factor: 0.6). 10/2009; 12(4):226-30. DOI: 10.4103/0972-2327.58276
Source: PubMed


The diagnosis of multiple sclerosis (MS) requires objective findings referable to the central nervous system. A wide differential diagnosis often has to be considered. Magnetic resonance imaging and electrophysiologic and cerebrospinal fluid studies can all contribute to an early definitive diagnosis. The McDonald diagnostic criteria for MS (2005) are the currently recognized MS diagnostic criteria. The clinical subtypes of MS and their diagnosis are discussed in this article. Being informed of the diagnosis may be a stressful experience for the patient and this is also dealt with.

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    • "Is cervical decompression beneficial in patients with coexistent cervical stenosis and multiple sclerosis? J Clin Neurosci (2014), criteria used today, which utilize MRI and other neurophysiology and laboratory testing to help establish early diagnosis and treatment [4]. The management of patients with MS and concomitant CS is challenging. "
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    ABSTRACT: Cervical stenosis (CS) and multiple sclerosis (MS) are two common conditions with distinctive pathophysiology but overlapping clinical manifestations. The uncertainty involved in attributing worsening symptoms to CS in patients with MS due to extremely high prevalence of asymptomatic radiological CS makes treatment decisions challenging. A retrospective review was performed analyzing the medical records of all patients with confirmed diagnosis of MS who had coexistent CS and underwent surgery for cervical radiculopathy/myeloradiculopathy. Eighteen patients with coexistent CS and MS who had undergone cervical spine decompression and fusion were identified. There were six men and 12 women with an average age of 52.7years (range 40-72years). Pre-operative symptoms included progressive myelopathy (14 patients), neck pain (seven patients), radiculopathy (five patients), and bladder dysfunction (seven patients). Thirteen of the 14 patients (92.9%) with myelopathy showed either improvement (4/14, 28.6%) or stabilization (9/14, 64.3%) in their symptoms with neck pain and radiculopathy improving in 100% and 80% of patients, respectively. None of the seven patients with urinary dysfunction had improvement in urinary symptoms after surgery. To conclude, cervical spine decompression and fusion can improve or stabilize myelopathy, and significantly relieve neck pain and radiculopathy in the majority of patients with coexistent CS and MS. Urinary dysfunctions appear unlikely to improve after surgery. The low rate of surgical complications in our cohort demonstrates that cervical spine surgery can be safely performed in carefully selected patients with concomitant CS and MS with a good clinical outcome and also eliminate CS as a confounding factor in the long-term management of MS patients.
    Journal of Clinical Neuroscience 07/2014; 21(12). DOI:10.1016/j.jocn.2014.05.023 · 1.38 Impact Factor
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    • "It presents with varying symptoms such as muscle fatigue, paralysis, loss of sensation/numbness, and pain, as well as emotional impairments such as depression and other mood disorders. The disease has diverse phenotypes.3 The majority of MS patients initially present with subacute attacks, with symptoms and signs referable to the central nervous system (CNS) – defined as a clinically isolated syndrome (CIS).4 "
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    ABSTRACT: For many years, central dogma defined multiple sclerosis (MS) as a T cell-driven autoimmune disorder; however, over the past decade there has been a burgeoning recognition that B cells contribute to the pathogenesis of certain MS disease subtypes. B cells may contribute to MS pathogenesis through production of autoantibodies (or antibodies directed at foreign bodies, which unfortunately cross-react with self-antigens), through promotion of T cell activation via antigen presentation, or through production of cytokines. This review highlights evidence for antibody-dependent and antibody-independent B cell involvement in MS pathogenesis.
    Biologics: Targets & Therapy 05/2012; 6:117-23. DOI:10.2147/BTT.S24734
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