Diagnosis: making it early and getting it right

There has been a growing consensus that early diagnosis is key to ensuring the best long term outcomes for people with MS. In particular, the Brain Health: Time Matters in MS initiative makes a very strong case for early diagnosis and intervention in order to preserve brain health in people with MS.

However, MS treatments are not free of risks and side-effects. Therefore the pressure to make an early diagnosis also needs to be balanced with getting the diagnosis right, so that people who may not have MS are not inappropriately treated.

In an effort to refine diagnostic methods, the European Magnetic Resonance Imaging in MS (MAGNIMS) group have published work comparing two different diagnostic criteria. They used these criteria to predict which people with the earliest signs of possible MS are most likely to go on to a full diagnosis of clinically definite MS. The research was published in the Journal of Neurology, Neurosurgery and Psychiatry in July.

The diagnosis of MS relies on the concept of ‘Dissemination in space and time’. This means that a person must have more than one attack or lesion over time, and/or in more than one region of the brain and/or spinal cord.

The two criteria they were comparing were published in 2010. The researchers undertook a study to compare the ability of these two methods to predict a diagnosis of MS in 87 people presenting with CIS at five different MS clinics across Europe.

The McDonald criteria uses MRI scans to look for lesions, if there is only new lesions then a person receives the diagnosis of Clinically Isolated Syndrome (CIS). If there is evidence of new and previous lesion, the diagnosis of MS is given. The Filippi-2010 criteria are similar, but also include the specific location of lesions, in particular the identification of at least one lesion in the cortex (the outermost part of the brain), also called intracortical lesions.

The researchers found that both criteria were very sensitive when predicting if people with CIS would convert to clinically definite MS . However, the Filippi criteria were able to predict conversion to MS more specifically and rule out other conditions.

They concluded that including intracortical lesions in the diagnostic assessment of patients with CIS will greatly improve the prediction and early diagnosis of MS. Intracortical lesions have been shown to be present in up to 40% of patients with MS, but not in patients with other neurological conditions.

Imaging and identifying intracortical lesions can be more challenging than imaging and identifying lesions in other locations of the brain and spinal cord. However, their value in identifying people who are more likely to develop MS has been made clearer by this study.

Further research is needed to confirm these findings and to make it easier for more clinics to use this diagnostic feature, but little by little the use of MRI to make accurate diagnoses and even provide prognostic information for people with MS is becoming more sophisticated.

With thanks to MS Research Australia – the lead provider of research summaries on our website