1 Clinical and research criteria for making the diagnosis have evolved over time, most recently 2 incorporating use of MRIs to a significant degree.
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A recently published report reinforces this notion, especially when the first symptoms are sensory in nature. Patients diagnosed prior to the introduction of magnetic resonance imaging (MRI) technology often describe years of symptom complaints and doctor’s visits prior to receiving a correct diagnosis. Historically, multiple sclerosis (MS) has been perceived as a disease that is particularly difficult to diagnose. With respect to the diagnosis of MS, greater training of primary care professionals, neurologists, and radiologists is necessary. Of patients referred because of abnormal MRI results who did not have MS or possible MS, 70% had a clear alternative etiology for the abnormal MRI results, including migraine, age older than 50 years, other neurological disease, or hypertension.Ĭonclusions A significant percentage of patients referred to a university-based MS center have little or no likelihood of having MS, and many have undiagnosed, untreated psychiatric illness or common conditions with abnormal brain MRI results. Of the 63% of patients referred on the basis of clinical symptoms and signs, 46% were diagnosed with MS or possible MS vs 11% of patients referred primarily on the basis of abnormal brain magnetic resonance imaging (MRI) results ( P<.001). Of patients with typical, possible, or atypical demyelinating syndromes, 71%, 27%, and 0%, respectively ( P<.001), had MS or possible MS. The rest had other neurological conditions (31.5%), probable psychiatric diagnoses (22.5%), or no clear diagnosis was made (12.5%). Results Of 281 patients referred to evaluate the possibility of MS, after initial review 33% were diagnosed with MS or possible MS by the McDonald criteria. Methods Retrospective medical record review of all new patient visits to University of Colorado Multiple Sclerosis Center, Denver, from January 1, 2001, to June 30, 2003. Objective To evaluate diagnostic outcomes, especially as they relate to reason for referral, of patients referred to a university-based multiple sclerosis (MS) center for possible MS.
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Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.