Subtle upper limb impairment in asymptomatic multiple sclerosis subjects

2007 ◽  
Vol 13 (3) ◽  
pp. 428-432 ◽  
Author(s):  
C. Solaro ◽  
G. Brichetto ◽  
M. Casadio ◽  
L. Roccatagliata ◽  
P. Ruggiu ◽  
...  

We evaluated upper limb function in multiple sclerosis (MS) subjects (11 clinically definite MS patients and seven clinically isolated syndrome (CIS) subjects), with a normal upper limb standard neurological examination. Subjects performed center-out reaching movements under visual control, with and without vision of the hand. Their movements were recorded through a digitizing tablet. Motor performance was also related to lesion load, estimated from magnetic resonance imaging (MRI). We found that in MS and CIS subjects, under the hand vision condition, movements were significantly less smooth, and had a less symmetric speed profile. However, the observed impairment did not correlate with MRI findings. This result may be interpreted as evidence of a compensatory strategy, elicited by subtle alterations in sensorimotor control. Multiple Sclerosis 2007; 13: 428-432. http://msj.sagepub.com

2016 ◽  
Vol 23 (7) ◽  
pp. 1031-1034 ◽  
Author(s):  
Wallace J Brownlee ◽  
Katherine A Miszkiel ◽  
Daniel R Altmann ◽  
Olga Ciccarelli ◽  
David H Miller

In patients who present with a clinically isolated syndrome (CIS), whose features are suggestive of multiple sclerosis (MS), fulfilling McDonald 2010 magnetic resonance imaging (MRI) criteria for dissemination in space (DIS) and dissemination in time (DIT) enables a diagnosis of MS. While ⩾1 periventricular lesion is included in the 2010 DIS criteria, earlier McDonald criteria required ⩾3 periventricular lesions to confirm DIS and recent Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS)-recommended DIS criteria also require ⩾3 lesions. We investigated the effect of varying the required number of periventricular lesions and found that the best combination of specificity and sensitivity for clinically definite MS was seen for ⩾1 periventricular lesion using both the McDonald 2010 and MAGNIMS 2016 criteria.


Author(s):  
Anthony Traboulsee ◽  
Laurent Létourneau-Guillon ◽  
Mark Steven Freedman ◽  
Paul W. O’Connor ◽  
Aditya Bharatha ◽  
...  

AbstractBackground: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.


2003 ◽  
Vol 9 (1) ◽  
pp. 55-58 ◽  
Author(s):  
Elliot M Frohman ◽  
Teresa C Frohman

This paper describes an unusual clinically isolated syndrome of inflammatory demyelination that was characterized by a right VI nerve palsy and right internuclear ophthalmoparesis (INO), along with an unusual form of dissociated nystagmus. Magnetic resonance imaging (MRI) revealed an isolated lesion within the right dorsomediolateral pontine tegmentum. Four years later, the subject developed a partial sensory transverse myelitis, confirming clinically definite multiple sclerosis (MS). This paper extends the range of isolated syndromes associated with MS.


2012 ◽  
Vol 19 (3) ◽  
pp. 271-280 ◽  
Author(s):  
Tobias Granberg ◽  
Juha Martola ◽  
Maria Kristoffersen-Wiberg ◽  
Peter Aspelin ◽  
Sten Fredrikson

With increasing availability of magnetic resonance imaging (MRI), there is also an increase in incidental abnormal findings. MRI findings suggestive of multiple sclerosis in persons without typical multiple sclerosis symptoms and with normal neurological findings are defined as radiologically isolated syndrome (RIS). Half of the persons with RIS have their initial MRI because of headache, and some have a subclinical cognitive impairment similar to that seen in multiple sclerosis. Radiological measurements also show a similarity between RIS and multiple sclerosis. Approximately two-thirds of persons with RIS show radiological progression and one-third develop neurological symptoms during mean follow-up times of up to five years. Cervical cord lesions are important predictors of clinical conversion. Management has to be individualised, but initiation of disease modifying therapy is controversial and not recommended outside of clinical trials since its effects have not been studied in RIS. Future studies should try to establish the prevalence and long-term prognosis of RIS, its impact on quality of life, and define the role of disease modifying therapy in RIS.


2007 ◽  
Vol 13 (6) ◽  
pp. 814-816 ◽  
Author(s):  
A. Pichiecchio ◽  
R. Bergamaschi ◽  
E. Tavazzi ◽  
A. Romani ◽  
A. Todeschini ◽  
...  

We report on clinical and instrumental findings of a multiple sclerosis (MS) patient with sudden right trigeminal neuralgia (TN). Magnetic resonance imaging (MRI), performed at TN onset, showed enlargement of both trigeminal nerves (TrN) at the root entry zone, with gadolinium enhancement of the cisternal portion. This is the first description of clinical and MRI findings indicative of peripheral involvement of the fifth cranial nerve in a MS patient complaining of TN. Our report shows the concomitant involvement of central and peripheral myelin in MS, and adds further highlights to the question regarding peripheral nerve involvement abnormalities associated with a disease considered limited to the central nervous system (CNS). Multiple Sclerosis 2007; 13: 814-816. http://msj.sagepub.com


2009 ◽  
Vol 16 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Gauthier Calais ◽  
Gerard Forzy ◽  
Charlotte Crinquette ◽  
Alexandre Mackowiak ◽  
Jerome de Seze ◽  
...  

In clinically isolated syndrome (CIS), the detection of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is critical for space dissemination validation when magnetic resonance imaging (MRI) diagnostic criteria are not fulfilled. However, lumbar puncture for CSF collection is considered relatively invasive. Previous studies have demonstrated applicability of OCB detection in tears to the diagnosis of multiple sclerosis (MS). The objective of the present study was to assess concordance between OCB detection in tears and in CSF. We have prospectively included patients with CIS and compared results of CSF and tear OCB detection by isoelectric focusing (IEF). Tears were collected using a Schirmer strip. We included 82 patients. For 69 of them, samples were analysable. OCBs were detected in CSF for 63.8% and in tears for 42% of patients. All patients with tear OCBs had CSF OCBs. We suggest that tear OCB detection may replace CSF OCB detection as a diagnostic tool in patients with CIS. This would circumvent the practice of invasive lumbar punctures currently used in MS diagnosis.


2004 ◽  
Vol 10 (6) ◽  
pp. 705-707 ◽  
Author(s):  
Yang Mao-Draayer ◽  
Hillel Panitch

The syndrome of alexia without agraphia occurs rarely in multiple sclerosis (MS). We report a patient with right homonymous hemianopsia and alexia without agraphia as his initial manifestations of relapsing-remitting MS. Magnetic resonance imaging (MRI) demonstrated a hyperintense lesion in the left occipital subcortical white matter (WM) and an enhancing lesion in the splenium of the corpus callosum. The clinical presentation and MRI findings were consistent with disconnection of the functional right occipital visual cortex from structures responsible for language comprehension in the left hemisphere. The diagnosis of MS was confirmed by subsequent development of additional periventricular WM lesions.


2000 ◽  
Vol 2 (2) ◽  
pp. 16-26
Author(s):  
Timothy Vollmer

Abstract Over the past decade, magnetic resonance imaging (MRI) has been increasingly used as a tool to facilitate the diagnosis of multiple sclerosis (MS). Because of the relative insensitivity of commonly used clinical assessment measures, however, clinicians are exploring ways in which MRI can be used to determine a patient's prognosis and track progression of the disease. This article discusses the MRI findings that may be useful in evaluating disease progression in MS; results of recent clinical trials of MS treatment agents that have employed MRI; and potential applications for MRI in clinical practice.


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