(ECTRIMS 2017) Revised McDonald criteria for diagnosing MS

[agate]

This article in MedPage Today (October 26) summarizes a presentation at the recent ECTRIMS conference (Paris, October 25-28) about the revised McDonald criteria for diagnosing MS. The McDonald criteria have been in use for quite a while for establishing a diagnosis of MS, and now they are being revised to include the presence of oligoclonal bands in the spinal fluid--which means that anyone who is apt to be diagnosed with MS is likely to have a spinal tap (lumbar puncture) done as part of the diagnostic workup.

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[Howie]

I never had a spinal tap for my dx, only an MRI. I don't know if I would agree to one, that's just too invasive.

[agate]

I never had one either. The neuro who diagnosed me wanted to spare me that experience, and I'm glad I got out of it. Some people sail through it but others find it pretty hard.

[Sunshine]

After my first attack, the MRI was clean, but the exam and history pointed toward MS. The neurologist said down with me and my husband and recommended a lumbar puncture. I am mediately said I did not want to do that. My husband, however, who is a very rational person and educated, said to me that I should do it. The doctor was in the room during this discussion

So, a few weeks later I had a lumbar puncture. It came back with 1 o band in it or maybe it was two. I remember the doctor saying that the spinal fluid did not disconfirm MS nor did it confirm it. He then had the nerve to say to me that I had talked him into doing it. I wish my husband was in the room for that visit. That was when I knew I would never go back there again.

And I didn’t. I did get two university opinions after that and settled on a wonderful local neurologist to follow me.

In any case, I was so frightened before hand that they gave me some kind of medication to relax me. I did not remember the puncture later on.



Later on, a physician friend mentioned that if you ever have to have a lumbar puncture, he would have an anesthesiologist do it, not a neurologist. The Anesthesiologists use smaller needles and do 100 times more of these in their practice because it is used for so many procedures.

I thought that was excellent advice and I pass it on to anybody who might be in the process of getting diagnosed and reads this.

[nuthatch]

I also had a lumbar puncture done while in the diagnosis process. As I recall I had 3 obands in my spinal fluid. I had the procedure done under fluoroscope as an outpatient at the hospital. At the time docs were trying to decide if I had MS or Lupus. I had already tested (and still do to this day!) with a rather elevated ANA blood test (with speckled pattern), an elevated sedimentation rate, and I also tested positive one time for the Smith antibody. That was retested and came back neg. so it may have been a false positive. My brother had been diagnosed with Discoid Lupus a few years earlier, so his diagnosis muddled the waters for me. At the time, it seemed like there was a tug-of-war going on between a neurologist and a rheumatologist as to who would get me as a patient. What a huge hassle! The neuro won, lucky me.

When I think back now, I find it interesting that both my brother's initial issue leading to his diagnosis, and my initial issue leading to my own diagnosis were immediately following instances of getting severely overheated. It sure makes me feel sun or heat has something to do with triggering these diseases.

[agate]

Interesting, nuthatch. I had elevated ANA results too, about a year before the MS was diagnosed. I had no idea what that abnormal lab test result meant except that the doctor wrote me a note saying I needed to look into the possibility of "muscular rheumatism." That sounded harmless and I didn't follow up on that at the time.

I hope that the neurologist you landed turned out to be a good doctor who gives enough attention to your care.

[Cherie]

The other thing that is being included in the Revised criteria is that the presence of Cortical lesions now may factor in and not just juxtacortical lesions. I also have had two spinal taps. Both of which had lab errors and lost specimen. Both had elevated protein but no O banding done and when the lab was called and asked to rerun the test, they had discarded the specimen. Since I am allergic to local anesthetics, I had both done with no local anesthetic. Not that bad but not something I would waltz into lightly again.

[stillstANNding]

My first one was "lost." The second one was only tested for the medical things that are normally tested when looking for the source of fever. Neuro was livid.

ANN

[Cherie]

My first one was "lost." The second one was only tested for the medical things that are normally tested when looking for the source of fever. Neuro was livid.

ANN

sorry to hear but it feels a bit better knowing I am not alone in that.