Abstract

Abstract:
Accurate Diagnosis of MS: Getting it Right

This Teaching Course focuses on three 30-minute presentations. Each will begin with a brief case, and end with a brief Q&A.

Dr. PK Coyle will discuss diagnostic issues and guidelines, including the rationale for early diagnosis, optimal use of the 2017 revised McDonald criteria, and general misdiagnosis principles.

Dr. Wallace Brownlee will cover differential diagnosis, including the major alternative diagnoses for relapsing or progressive presentations and key diagnostic clues.

Dr. Georgina Arrambide will present pearls on ancillary diagnostic testing, including updates on MRI standardization and novel techniques, use of CSF, optical coherence tomography, and other novel approaches to diagnosis.

Abstract

Making a diagnosis of multiple sclerosis (MS) is not always straight-forward. The myriad of ways MS can present clinically and radiologically, an extensive differential diagnosis, and the absence of a pathognomonic diagnostic test, frequently represents a challenge for neurologists. The McDonald criteria require the integration of clinical, MRI and laboratory assessments in patients with symptoms suggestive of demyelination. The 2017 McDonald criteria allow for an accurate and even earlier diagnosis of MS when applied in the appropriate clinical setting. Misdiagnosis of MS is an important issue, in part driven by misapplication and misinterpretation of the McDonald criteria. Misdiagnosis has serious implications and can lead to direct harm to patients from unnecessary exposure to MS disease-modifying therapies.

Our proposed educational course will deliver an overview of MS diagnosis, focussing on the importance of identifying typical symptoms of MS, and the importance of seeking objective evidence of lesions; the integration of MRI and CSF examination findings into the diagnostic schema for MS; and the better explanations in real-world settings, including practical steps to avoid misdiagnosis based on atypical clinical features and “red flags”. We aim to combine lectures from individual speakers with interactive clinical case presentations (utilising an audience participation system) to highlight key learning points while integrating contemporary data.