1. Multiple Sclerosis (MS) is a disease of the central nervous system that results in demyelination and damage to the protective myelin sheaths surrounding nerve fibers. Common symptoms include visual problems, muscle weakness, sensory issues, and coordination and balance issues. 2. The diagnosis of MS is based on clinical evidence of lesions in the brain and spinal cord disseminated in time and space. MRI and lumbar puncture are important tests to support the diagnosis. 3. There are different clinical courses of MS including relapsing-remitting, secondary-progressive, primary-progressive and progressive-relapsing. The McDonald criteria from 2001 is now commonly used to diagnose MS based on clinical and

1. Multiple Sclerosis Diagnostic Issues Christopher Bourque

7. McDonald Criteria Next slide 1 0 (progression from onset) Dissemination in space by MRI or positive CSF and 2 or more MRI lesions consistent with MS and dissemination in time by MRI or second clinical attack 1 1 monosymptomatic Dissemination in time by MRI or second clinical attack 2 or more 1 Dissemination in space by MRI or positive CSF and 2 or more MRI lesions consistent with MS or further clinical attack involving different site 1 2 or more None 2 or more 2 or more Additional Requirements to Make Diagnosis Objective Lesions Clinical (attacks)

8. McDonald Criteria Positive CSF and Dissemination in space by MRI evidence of 9 or more T2 brain lesions or 2 or more cord lesions or 4-8 brain and 1 cord lesion or positive VEP with 4-8 MRI lesions or positive VEP with less than 4 brain lesions plus 1 cord lesion and Dissemination in time by MRI or continued progression for 1 year 1 0 (progression from onset) Additional Requirements to Make Diagnosis Objective Lesions Clinical (attacks)

11. MS Symptoms Source: Whitaker JN, Mitchell GW 1997 100 88 87 82 63 39 49 42 41 23 10 4 Visual/oculomotor Paresis Paresthesias Incoordination Genitourinary/bowel Cerebral During course % Presenting % Deficit reported

23. MS Symptoms Source: Whitaker JN, Mitchell GW 1997 100 88 87 82 63 39 49 42 41 23 10 4 Visual/oculomotor Paresis Paresthesias Incoordination Genitourinary/bowel Cerebral During course % Presenting % Deficit reported