Selection of electrophysiological tests in patients with suspected multiple sclerosis

If we accept the criteria set by McDonald and Halliday and by the Boston University WorkShop that one of the two lesions in patients with multiple sclerosis may be determined by electrophysiological tests and if we recognize that medical economics sets a limit to indiscriminate use of tests for clinical purposes, we need to pay particular attention to the selection of diagnostic tests. If we accept that certain anatomical predilections of plaques at the onset of multiple sclerosis correlate to a limited extent with long-term prognosis as suggested by Kurtzke, Rosati and Visscher, particularly with the relation to the disability and mortality, we need to pay more attention to the discovery of symptoms and signs as soon as possible utilizing clinical and laboratory data. As of now, the frequency of symptoms and signs at the onset of multiple sclerosis, with minor variations, seem to indicate that motor signs (pyramidal and cerebellar) head the list. Electrophysiological tests are specific for certain anatomical systems. The sensitivity of each test varies, but in most series electrooculography and electronystagmography offer the greater sensitivity. This is because of the significant interconnections between the pyramidal, cerebellar, vestibular and the oculomotor systems. This report underlines the importance of these two electrophysiological tests for the diagnosis of suspected multiple sclerosis.