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      Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria


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          New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Ann Neurol 2011

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          Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis.

          The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with dinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including "monosymptomatic" disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as "clinically definite" and "probable MS" are no longer recommended. The outcome of a diagnostic evaluation is either MS, "possible MS" (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or "not MS."
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            A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.

            Neuromyelitis optica is an inflammatory demyelinating disease with generally poor prognosis that selectively targets optic nerves and spinal cord. It is commonly misdiagnosed as multiple sclerosis. Neither disease has a distinguishing biomarker, but optimum treatments differ. The relation of neuromyelitis optica to optic-spinal multiple sclerosis in Asia is uncertain. We assessed the capacity of a putative marker for neuromyelitis optica (NMO-IgG) to distinguish neuromyelitis optica and related disorders from multiple sclerosis. Indirect immunofluorescence with a composite substrate of mouse tissues identified a distinctive NMO-IgG staining pattern, which we characterised further by dual immunostaining. We tested masked serum samples from 102 North American patients with neuromyelitis optica or with syndromes that suggest high risk of the disorder, and 12 Japanese patients with optic-spinal multiple sclerosis. Control patients had multiple sclerosis, other myelopathies, optic neuropathies, and miscellaneous disorders. We also established clinical diagnoses for 14 patients incidentally shown to have NMO-IgG among 85000 tested for suspected paraneoplastic autoimmunity. NMO-IgG outlines CNS microvessels, pia, subpia, and Virchow-Robin space. It partly colocalises with laminin. Sensitivity and specificity were 73% (95% CI 60-86) and 91% (79-100) for neuromyelitis optica and 58% (30-86) and 100% (66-100) for optic-spinal multiple sclerosis. NMO-IgG was detected in half of patients with high-risk syndromes. Of 14 seropositive cases identified incidentally, 12 had neuromyelitis optica or a high-risk syndrome for the disease. NMO-IgG is a specific marker autoantibody of neuromyelitis optica and binds at or near the blood-brain barrier. It distinguishes neuromyelitis optica from multiple sclerosis. Asian optic-spinal multiple sclerosis seems to be the same as neuromyelitis optica.
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              Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria".

              New diagnostic criteria for multiple sclerosis integrating magnetic resonance image assessment with clinical and other paraclinical methods were introduced in 2001. The "McDonald Criteria" have been extensively assessed and used since 2001. New evidence and consensus now strengthen the role of these criteria in the multiple sclerosis diagnostic workup to demonstrate dissemination of lesions in time, to clarify the use of spinal cord lesions, and to simplify diagnosis of primary progressive disease. The 2005 Revisions to the McDonald Diagnostic Criteria for MS should simplify and speed diagnosis, whereas maintaining adequate sensitivity and specificity.

                Author and article information

                Ann Neurol
                Annals of Neurology
                Wiley Subscription Services, Inc., A Wiley Company
                February 2011
                : 69
                : 2
                : 292-302
                [1 ]simpleDepartment of Neurology, Free University Amsterdam, the Netherlands
                [2 ]simpleScientific and Clinical Review Associates LLC New York, NY
                [3 ]simpleDivision of Neurology, Hospital for Sick Children Toronto, Ontario, Canada
                [4 ]simpleDepartment of Neurosciences, University Hospital Center Toulouse, France
                [5 ]simpleMellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinical Foundation Cleveland, OH
                [6 ]simpleNeuroimaging Research Unit, Division of Neuroscience, Scientific Institute and University Hospital San Raffaele Milan, Italy
                [7 ]simpleDepartment of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine Sendai, Japan
                [8 ]simpleDepartment of Neurology, First Faculty of Medicine, Charles University Prague, Czech Republic
                [9 ]simpleSt Vincent's University Hospital Elm Park, Dublin, Ireland
                [10 ]simpleDepartments of Neurology and Biomedicine, University Hospital, Kantonsspital Basel, Switzerland
                [11 ]simpleCorrine Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Mount Sinai School of Medicine New York, NY
                [12 ]simpleClinical Neuroimmunology Unit, Multiple Sclerosis Center of Catalonia, University Hospital Vall d'Hebron Barcelona, Spain
                [13 ]simpleDivision of Neurology, St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada
                [14 ]simpleDepartment of Neurology, University Hospital Lund, Sweden
                [15 ]simpleUniversity College London Institute of Neurology United Kingdom
                [16 ]simpleMultiple Sclerosis Center, University of California San Francisco, CA
                [17 ]simpleDepartment of Neurology, Mayo Clinic Rochester, MN
                [18 ]simpleDepartment of Neurology, University of Texas Health Sciences Center Houston, TX
                Author notes
                Address correspondence to Dr Polman, Department of Neurology, VU Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands. E-mail: ch.polman@ 123456vumc.nl
                Copyright © 2011 American Neurological Association

                Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

                : 02 November 2010
                : 23 December 2010
                : 29 December 2010
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