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Primary progressive multiple sclerosis: clinical and paraclinical characteristics with application of the new
I Dujmović1, S Mesaros, T Pekmezović
1Institute of Neurology, University of Belgrade, School of Medicine, Dr Subotića, Belgrade, Yugoslavia. irdujm@EUnet.yu
Abstract:
The aim of our study was to analyse clinical and paraclinical characteristics of patients with multiple sclerosis (MS) with previous diagnosis of primary-progressive (PP) MS according to the Poser's criteria and further investigate if they fulfil the McDonald's diagnostic criteria for this disorder. A total of 561 MS patients were registered in the database at the Institute of Neurology, Belgrade, from 1 January 1997 to 31 December 2000 and 63 of them (11.2%) with previous diagnosis of PPMS were analysed retrospectively. Male/female ratio was 1.3:1 and mean age at onset 33.2 years. Most frequent at onset were pyramidal (in 73% of patients) and sensory symptoms (in 41% of patients); 74.6% of patients had greater than or equal to nine brain magnetic resonance imaging (MRI) lesions. Intrathecal oligoclonal immunoglobulin G (IgG) was detected in 96.7% and prolonged visual evoked potentials (VEP) P100 latency in 82.4% of patients. Of the total study group of 561 patients, 10.2% fulfilled the recently recommended McDonald's diagnostic criteria for the diagnosis of PPMS. Our findings further support the significance of the brain/spinal cord MRI, cerebrospinal fluid and VEP findings for precise diagnostic assessment in patients with suspected PP form of MS.
Insights
This study evaluated primary-progressive multiple sclerosis (PPMS) patients, finding that brain MRI, cerebrospinal fluid analysis, and visual evoked potentials are crucial for accurate PPMS diagnosis. Many patients previously diagnosed did not meet newer criteria.
Area of Science:
- Neurology
- Neuroimmunology
- Clinical Neuroscience
Background:
- Multiple sclerosis (MS) diagnosis, particularly the primary-progressive form (PPMS), has evolved with changing criteria.
- Accurate diagnostic criteria are essential for timely and appropriate patient management.
Purpose of the Study:
- To analyze clinical and paraclinical features of patients diagnosed with PPMS using Poser's criteria.
- To determine how many of these patients meet the more recent McDonald's diagnostic criteria for PPMS.
- To underscore the importance of specific diagnostic tools in PPMS assessment.
Main Methods:
- Retrospective analysis of 63 patients with a previous PPMS diagnosis from a larger cohort of 561 MS patients.
- Evaluation of clinical symptoms, brain magnetic resonance imaging (MRI) findings, intrathecal oligoclonal immunoglobulin G (IgG) presence, and prolonged visual evoked potentials (VEP) P100 latency.
- Comparison of patient data against Poser's and McDonald's diagnostic criteria.
Main Results:
- The study included 63 patients (11.2% of the cohort) with a prior PPMS diagnosis.
- Common onset symptoms included pyramidal (73%) and sensory (41%) deficits.
- High rates of diagnostic indicators were observed: brain MRI lesions (74.6%), oligoclonal IgG (96.7%), and prolonged VEP P100 latency (82.4%).
- Only 10.2% of the analyzed patients met the McDonald's criteria for PPMS.
Conclusions:
- Clinical and paraclinical findings, including MRI, CSF analysis, and VEP, are vital for diagnosing PPMS.
- There is a notable discrepancy between older (Poser's) and newer (McDonald's) diagnostic criteria for PPMS.
- Refined diagnostic approaches are necessary for accurately identifying and managing PPMS patients.
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