The diagnosis of multiple sclerosis and the clinical subtypes

ArticleinAnnals of Indian Academy of Neurology 12(4):226-30 · October 2009with35 Reads
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.
    • "The paced auditory serial addition test (PASAT) was used to obtain data related to cognitive processing speed, and the modified fatigue impact scale (MFIS-5) was examined to measure the impact of fatigue on physical, cognitive, and psychosocial functioning. After diagnosis, the recruited patients were confirmed to exhibit the following characteristics: RRMS course (Hurwitz, 2009); EDSS score <2.5, which corresponds to minimal disability (Kurtzke, 2008); lacking visible lesions in the bilateral thalamus, which corresponds to a normal-appearing thalamus; and treatment with immunomodulatory medication . None of the recruited patients experienced any relapses, which were identified by follow-up neurological assessments and contrast-enhanced MRI after relapse onset (12 weeks), or received corticosteroid treatment during the month preceding MRI acquisition. "
    [Show abstract] [Hide abstract] ABSTRACT: The thalamus plays a crucial role in sensorimotor, cognitive and attentional circuit functions. Disruptions in thalamic connectivity are believed to underlie the symptoms of multiple sclerosis (MS). Therefore, assessing thalamocortical structural connectivity (SC) and functional connectivity (FC) may provide new insights into the mechanism of intrinsic functional plasticity in a large-scale neural network. We used resting-state FC measurement and diffusion tensor imaging probabilistic tractography to study the functional and structural integrity of the thalamocortical system in patients with relapsing-remitting MS (RRMS) and matched healthy controls. In the thalamocortical connections of RRMS patients, we found lesion load-related regional FC in the right temporal pole, which reflected compensatory hyperconnectivity related to lesion-related demyelination. We also found significant correlations between increased diffusivity and slowed cognitive processing (PASAT) or the impact of fatigue (MFIS-5), as well as between connective fiber loss and disease duration. Taken together, the evidence from SC and FC analysis of the thalamocortical system suggests that minimally disabled RRMS patients exhibit a dissociated SC-FC pattern and limited regional functional plasticity to compensate for the chronic demyelination-related loss of long-distance SC. These results also provide further evidence supporting the notion that MS is a disorder of anatomical disconnection.
    Full-text · Article · Jan 2016
    • "We recruited 34 patients with clinically definite RRMS according to McDonald's criteria [1] at the First Affiliated Hospital of Nanchang University from May 2010 to December 2013. The inclusion criteria for the patients included an RRMS course [45] and a history of treatment with immunomodulatory medication (20 with β-interferons and 4 with glatiramer acetate). In this study, 23 patients underwent one MRI scan during the remitting phase, and 11 patients underwent two MRI scans-one scan each during the relapsing and remitting phases, respectively . "
    [Show abstract] [Hide abstract] ABSTRACT: Advanced MRI studies have revealed regional alterations in the sensorimotor cortex of patients with relapsing-remitting multiple sclerosis (RRMS). However, the organizational features underlying the relapsing phase and the subsequent remitting phase have not been directly shown at the functional network or the connectome level. Therefore, this study aimed to characterize MS-related centrality disturbances of the sensorimotor network (SMN) and to assess network integrity and connectedness. Thirty-four patients with clinically definite RRMS and well-matched healthy controls participated in the study. Twenty-three patients in the remitting phase underwent one resting-state functional MRI, and 11 patients in the relapsing-remitting phase underwent two different MRIs. We measured voxel-wise centrality metrics to determine direct (degree centrality, DC) and global (eigenvector centrality, EC) functional relationships across the entire SMN. In the relapsing phase, DC was significantly decreased in the bilateral primary motor and somatosensory cortex (M1/S1), left dorsal premotor (PMd), and operculum-integrated regions. However, DC was increased in the peripheral SMN areas. The decrease in DC in the bilateral M1/S1 was associated with the expanded disability status scale (EDSS) and total white matter lesion loads (TWMLLs), suggesting that this adaptive response is related to the extent of brain damage in the rapid-onset attack stage. During the remission process, these alterations in centrality were restored in the bilateral M1/S1 and peripheral SMN areas. In the remitting phase, DC was reduced in the premotor, supplementary motor, and operculum-integrated regions, reflecting an adaptive response due to brain atrophy. However, DC was enhanced in the right M1 and left parietal-integrated regions, indicating chronic reorganization. In both the relapsing and remitting phases, the changes in EC and DC were similar. The alterations in centrality within the SMN indicate rapid plasticity and chronic reorganization with a biased impairment of specific functional areas in RRMS patients.
    Full-text · Article · Jun 2015
    • "The symptoms of MS largely depend on the location of the MS lesions but usually include visual impairment, sensory impairment, extremity weakness, bladder dysfunction, spasticity, discoordination and pain [2]. The diagnostic criteria for MS have changed over the years from a purely clinical diagnosis with the Schumacher criteria in 1965 to the most recent McDonald criteria used today, which utilize MRI and other neurophysiology and laboratory testing to help establish early diagnosis and treat- ment [4]. The management of patients with MS and concomitant CS is challenging. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jul 2014
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