Table 9.
Clinical presentation | Additional data needed for MS diagnosis |
---|---|
Two or more attcaksa; objective clinical evidence of two or more lesions Two or more attcaksa; objective clinical evidence of one lesion One attacka; objective clinical evidence of two or more lesions One attacka; objective clinical evidence of one lesion (monosymptomatic presentation; clinically isolated syndrome) Insidious neurological progression suggestive of MS |
Noneb Dissemination in space, demonstrated by:
Two of the following: |
If criteria indicated are fulfilled and there is no better explanation for the clinical presentation, the diagnosis is MS; if suspicious, but the criteria are not completely met, the diagnosis is “possible MS”; if another diagnosis arises during the evaluation that better explains the entire clinical presentation, then the diagnosis is “not MS.”
An attack is defined as an episode of neurological disturbance for which causative lesions are likely to be inflammatory and demyelinating in nature. There should be subjective report (backed up by objective findings) or objective observation that the event lasts for at least 24 hours.
No additional tests are required; however, if tests (MRI, CSF) are undertaken and are negative, extreme caution needs to be taken before making a diagnosis of MS. Alternative diagnoses must be considered. There must be no better explanation for the clinical picture and some objective evidence to support a diagnosis of MS.
MRI demonstration of space dissemination must fulfill the criteria in Table 10.
Positive CSF determined by oligoclonal bands detected by established methods (isoelectric focusing) different from any such bands in serum, or by an increased IgG index.
MRI demonstration of time dissemination must fulfill the criteria in Table 9.
Abnormal VEP of the type seen in MS.
MS: multiple sclerosis; MRI: magnetic resonance imaging; CSF: cerebrospinal fluid; VEP: visual-evoked potential.