Revised guidelines established for the diagnosis of multiple sclerosis (MS) are now stressing the greater use of magnetic resonance imaging (MRI) in assessing the extent of the disease.1
MRI: 'A Powerful Tool'
The new guidelines were published by an international panel of neurology experts in early November, updating the policy made public five years ago, known as the "McDonald Criteria".
"A series of studies performed during the last few years, with improved techniques for spinal cord MRI, shows that it is a powerful tool not only to demonstrate MS lesions, but also to exclude alternative diagnoses," said Chris Polman, MD, of the Free University Medical Center in Amsterdam, The Netherlands, and the panel's chairman.
"We hope and trust that these revisions will allow an even earlier diagnosis of MS without any loss of diagnostic accuracy," Polman stated.
Improved Diagnoses
The initial criteria, approved in 2001, were the first to include the use of MRI to visualize brain and spinal cord lesions as part of the standard diagnostic approach for MS that includes taking a patient's neurologic history, an examination, and conducting lab tests. Imaging the central nervous system using such approaches as MRI allows doctors to better visualize areas of damage from the disease, experts say.
The new criteria were formed based on new evidence, as well as consensus opinion, and recommends that neurologists pay close attention to them as a basis for patient diagnosis. The new guidelines, the panel stated, help to demonstrate dissemination of lesions in time, in order to clarify the use of spinal cord lesions, and to simplify the diagnosis of primary progressive MS.
Primary progressive MS is a form of the disease in which a slow, but continuing worsening of symptoms develops, with no distinct relapses or remissions. There are variations in the rates of disease progression as time goes on, as well as occasional lulls in symptoms and temporary minor improvements.2
"The changes in diagnostic criteria for primary progressive multiple sclerosis are particularly helpful," explained Robert Lisak, MD, of Wayne State University in Detroit, and chairman of the American Neurological Association's public information committee. "The ability to make the diagnosis of multiple sclerosis early and accurately is important for both patient care and for clinical research, including clinical trials of new treatments."
Reduced Number of Tests Recommended
The new diagnostic guidelines also recommend that only two separate MRI scans, rather than the currently recommended three, are needed to evaluate whether or not MS is progressing.
The criteria are aimed at helping doctors make an earlier diagnosis, which in turn, may help facilitate early treatment for the disease that can be more effective when started early in the course of the illness, the panelists stated.
The panel also recommends that studies be done to evaluate the effectiveness of the revised guidelines, particularly for relapsing-remitting MS, to further refine the still complex requirements for imaging results and to better scrutinize new imaging technologies.
1. Polman CH, Reingold SC, Edan G et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol 2005 Nov 10;58(6):840-6. [Epub ahead of print].
2. National Multiple Sclerosis Society. What is Multiple Sclerosis? Available at: http://www.nationalmssociety.org/What%20is%20MS.asp. Accessed December 5, 2005.
John Martin is a long-time health journalist and an editor for CuraScript. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
