Diagnosis in multiple sclerosis: past and present

Abstract

Because of lack of a gold test, the diagnosis of Multiple Sclerosis remains based on the clinical picture and helped by laboratory and magnetic resonance images assesment. There have been several combined criteria aimed to accurate diagnosis. The majority of them shares the dissemination of lesions in time and space and to have no better explanation for the symptoms. It has done an historic summary of the diagnostic criteria since Allison and Millard in 1954 until the last Mc Donald revised criteria, made by international panel in Amsterdam, with the chair of Polman in 2005. According to this, it was agreed that new T2 lesions on MRI at least one month after disease onset or detection of gadolinium enhancement at least 3 months after the onset, if not a site corresponding to the initial event, is enough for demostrating dissemination in time, allowing more rapid diagnosis and providing more flexibility imaging criteria. A spinal cord lesion can be considered equivalent to a brain infratentorial lesion to demostrate dissemination in space. Primary progresive MS can be diagnosed in the abscence of positive CSF findings, in the presence of typical brain MRI lesions. In the future probably the diagnosis would be more exactly with biologic, immunologic or genetic markers, but ever will be better the healthy medical judgment.