Multiple sclerosis resident survival guide: Difference between revisions

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==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
The [[diagnostic criteria]] for multiple sclerosis is [[McDonald criteria]].<ref name="pmid30658260">{{cite journal |vauthors=Gobbin F, Zanoni M, Marangi A, Orlandi R, Crestani L, Benedetti MD, Gajofatto A |title=2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity? |journal=Mult Scler Relat Disord |volume=29 |issue= |pages=23–25 |date=January 2019 |pmid=30658260 |doi=10.1016/j.msard.2019.01.008 |url=}}</ref><ref name="pmid114563022">{{cite journal |vauthors=McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |date=July 2001 |pmid=11456302 |doi= |url=}}</ref>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{|
{{familytree | | | | A01 | | | A01= }}
|-
{{familytree | | | | |!| | | | }}
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical presentation'''
{{familytree | | | | B01 | | | B01= }}
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional Data Needed'''
{{familytree | | |,|-|^|-|.| | }}
|-
{{familytree | | C01 | | C02 | C01= | C02= }}
| style="background: #DCDCDC; padding: 5px;" |
* 2 or more attacks (relapses) 
* 2 or more objective clinical lesions
| style="background: #F5F5F5; padding: 5px;" |
* None; [[clinical]] evidence will suffice (additional evidence desirable but must be consistent with MS)
|-
| style="background: #DCDCDC; padding: 5px;" |
* 2 or more attacks


{{familytree/end}}
* 1 objective clinical lesion
| style="background: #F5F5F5; padding: 5px;" |Dissemination in space, demonstrated by:
* [[MRI]]
* Further clinical attack involving different site
* Presence of 1 or more T2 [[lesions]] in at least 2 of 4 of the following areas of the [[CNS]]: Periventricular, Juxtacortical, [[Infratentorial]], or [[spinal cord]]
'''New criteria:''' Dissemination in Space (DIS) can be demonstrated by the .
|-
| style="background: #DCDCDC; padding: 5px;" |
* 1 attack
 
* 2 or more objective clinical lesions
| style="background: #F5F5F5; padding: 5px;" |Dissemination in time (DIT), demonstrated by:
* [[MRI contrast agent|MRI]]
* Second clinical attack
'''New criteria:''' No longer a need to have separate [[MRI|MRIs]] run; Dissemination in time, demonstrated by: Simultaneous presence of [[asymptomatic]] gadolinium-enhancing
 
and nonenhancing [[lesions]] at any time; or A new T2 and/or [[gadolinium]]-enhancing lesion(s) on follow-up [[MRI]], irrespective of its timing with reference to a baseline scan; or Await a second clinical attack. [This allows for quicker [[diagnosis]] without sacrificing [[specificity]], while improving [[sensitivity]]]
|-
| style="background: #DCDCDC; padding: 5px;" |
* 1 attack
 
* 1 objective clinical lesion (clinically isolated syndrome)
| style="background: #F5F5F5; padding: 5px;" |'''New criteria:''' Dissemination in space and time, demonstrated by:
* For DIS: 1 or more T2 [[lesion]] in at least 2 of 4 MS-typical regions of the [[CNS]] (periventricular, juxtacortical, [[infratentorial]], or [[spinal cord]]); or Await a second clinical attack implicating a different [[CNS]] site; and For DIT: Simultaneous presence of [[asymptomatic]] [[gadolinium]]-enhancing and non-enhancing [[Lesion|lesions]] at any time; or A new T2 and/or [[gadolinium]]-enhancing lesion(s) on follow-up [[MRI]], irrespective of its timing with reference to a baseline scan; or Await a second clinical attack.
 
*
|-
| style="background: #DCDCDC; padding: 5px;" |
* Insidious [[neurological]] progression suggestive of MS (primary progressive MS)
| style="background: #F5F5F5; padding: 5px;" |'''New criteria:''' One year of disease progression (retrospectively or prospectively determined) and two or three of the following:
* Evidence for DIS in the [[brain]] based on 1 or more T2 [[Lesion|lesions]] in the MS-characteristic (periventricular, juxtacortical, or [[infratentorial]]) regions
 
* Evidence for DIS in the spinal cord based on 2 or more T2 [[lesions]] in the cord
|}


==Treatment==
==Treatment==

Revision as of 23:12, 8 January 2021

Resident Survival Guide
Introduction
Team
Guide
Page Template
Examine the Patient Template
Navigation Bar Template
Checklist
Topics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Synonyms and keywords:

Overview

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

The diagnostic criteria for multiple sclerosis is McDonald criteria.[1][2]

Clinical presentation Additional Data Needed
  • 2 or more attacks (relapses)
  • 2 or more objective clinical lesions
  • None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
  • 2 or more attacks
  • 1 objective clinical lesion
 Dissemination in space, demonstrated by:
  • MRI
  • Further clinical attack involving different site
  • Presence of 1 or more T2 lesions in at least 2 of 4 of the following areas of the CNS: Periventricular, Juxtacortical, Infratentorial, or spinal cord

New criteria: Dissemination in Space (DIS) can be demonstrated by the .

  • 1 attack
  • 2 or more objective clinical lesions
 Dissemination in time (DIT), demonstrated by:
  • MRI
  • Second clinical attack

New criteria: No longer a need to have separate MRIs run; Dissemination in time, demonstrated by: Simultaneous presence of asymptomatic gadolinium-enhancing

and nonenhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or Await a second clinical attack. [This allows for quicker diagnosis without sacrificing specificity, while improving sensitivity]

  • 1 attack
  • 1 objective clinical lesion (clinically isolated syndrome)
 New criteria: Dissemination in space and time, demonstrated by:
  • For DIS: 1 or more T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord); or Await a second clinical attack implicating a different CNS site; and For DIT: Simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or Await a second clinical attack.
  • Insidious neurological progression suggestive of MS (primary progressive MS)
 New criteria: One year of disease progression (retrospectively or prospectively determined) and two or three of the following:
  • Evidence for DIS in the brain based on 1 or more T2 lesions in the MS-characteristic (periventricular, juxtacortical, or infratentorial) regions
  • Evidence for DIS in the spinal cord based on 2 or more T2 lesions in the cord

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

  • The content in this section is in bullet points.

Don'ts

  • The content in this section is in bullet points.

References

  1. ↑ Gobbin F, Zanoni M, Marangi A, Orlandi R, Crestani L, Benedetti MD, Gajofatto A (January 2019). "2017 McDonald criteria for multiple sclerosis: Earlier diagnosis with reduced specificity?". Mult Scler Relat Disord. 29: 23–25. doi:10.1016/j.msard.2019.01.008. PMID 30658260.
  2. ↑ McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.


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