FlorianDeisenhammer, Professor of Neurology, Dept. of Neurology, Innsbruck Medical Universityflorian.deisenhammer@uki.at
Florian Deisenhammer
Submitted June 20, 2012
Drs. Rudick and Miller discuss avoiding MS misdiagnosis, which occurs due to overuse and misinterpretation of MRI. [1] I agree but would like to emphasize the importance of investigation of CSF oligoclonal bands (OCB). It is incomprehensible that a diagnostic test of roughly 95% sensitivity and 85-90% specificity has been dropped in the latest version of MS diagnostic criteria. [2,3] Physicians and patients would readily utilize a diagnostic test with this type of proven performance. MS experts increasingly face patients who are referred because of unspecific MRI white matter lesions and those with somatoform disorders misdiagnosed as MS. In this context, the negative predictive value of 90% of a negative OCB result should also be stressed. [4] MS diagnostic criteria should include CSF investigation in the diagnosis of MS. There are also clear guidelines available on how to conduct CSF analyses. [3]
References
1. Rudick RA, Miller AE. Multiple sclerosis or multiple
possibilities: The continuing problem of misdiagnosis. Neurology 2012; 78:
1904-1906.
2. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292-302.
3. Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement. Arch Neurol 2005; 62: 865-870.
4. Bourahoui A, de Seze J, Guttierez R, et al. CSF isoelectrofocusing in a large cohort of MS and other neurological diseases. Eur J Neurol 2004; 11: 525-529.
For disclosures, contact the editorial office at journal@neurology.org.
Drs. Rudick and Miller discuss avoiding MS misdiagnosis, which occurs due to overuse and misinterpretation of MRI. [1] I agree but would like to emphasize the importance of investigation of CSF oligoclonal bands (OCB). It is incomprehensible that a diagnostic test of roughly 95% sensitivity and 85-90% specificity has been dropped in the latest version of MS diagnostic criteria. [2,3] Physicians and patients would readily utilize a diagnostic test with this type of proven performance. MS experts increasingly face patients who are referred because of unspecific MRI white matter lesions and those with somatoform disorders misdiagnosed as MS. In this context, the negative predictive value of 90% of a negative OCB result should also be stressed. [4] MS diagnostic criteria should include CSF investigation in the diagnosis of MS. There are also clear guidelines available on how to conduct CSF analyses. [3]
References
1. Rudick RA, Miller AE. Multiple sclerosis or multiple possibilities: The continuing problem of misdiagnosis. Neurology 2012; 78: 1904-1906.
2. Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292-302.
3. Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement. Arch Neurol 2005; 62: 865-870.
4. Bourahoui A, de Seze J, Guttierez R, et al. CSF isoelectrofocusing in a large cohort of MS and other neurological diseases. Eur J Neurol 2004; 11: 525-529.
For disclosures, contact the editorial office at journal@neurology.org.