Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence

A. Boster, C. Caon, J. Perumal, S. Hreha, Rana K Zabad, I. Zak, A. Tselis, R. Lisak, Omar Khan

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnosis investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assements and persistent neurologic symptoms. Methods: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. Results: All 143 patients had normal initial examinations, brain MRl scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervicial cord n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.996), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord, imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. Conclusions: Patients and clinicians may be reassured that peristent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.

Original languageEnglish (US)
Pages (from-to)804-808
Number of pages5
JournalMultiple Sclerosis
Volume14
Issue number6
DOIs
StatePublished - Jul 1 2008

Fingerprint

Neurologic Manifestations
Multiple Sclerosis
Spinal Cord
Cerebrospinal Fluid
Neurologic Examination
Magnetic Resonance Imaging
Somatosensory Evoked Potentials
Visual Evoked Potentials
Brain Stem Auditory Evoked Potentials
Brain
Hematologic Tests
Evoked Potentials
Referral and Consultation

Keywords

  • CNS symptoms
  • Demyelinating disease
  • Diagnostic criteria
  • Multiple sclerosis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence. / Boster, A.; Caon, C.; Perumal, J.; Hreha, S.; Zabad, Rana K; Zak, I.; Tselis, A.; Lisak, R.; Khan, Omar.

In: Multiple Sclerosis, Vol. 14, No. 6, 01.07.2008, p. 804-808.

Research output: Contribution to journalArticle

Boster, A, Caon, C, Perumal, J, Hreha, S, Zabad, RK, Zak, I, Tselis, A, Lisak, R & Khan, O 2008, 'Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence', Multiple Sclerosis, vol. 14, no. 6, pp. 804-808. https://doi.org/10.1177/1352458507088156
Boster, A. ; Caon, C. ; Perumal, J. ; Hreha, S. ; Zabad, Rana K ; Zak, I. ; Tselis, A. ; Lisak, R. ; Khan, Omar. / Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence. In: Multiple Sclerosis. 2008 ; Vol. 14, No. 6. pp. 804-808.
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abstract = "Background: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnosis investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assements and persistent neurologic symptoms. Methods: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. Results: All 143 patients had normal initial examinations, brain MRl scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervicial cord n = 126; 88.1{\%}; thoracic cord, n = 58; 40.6{\%}). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1{\%}), somatosensory evoked potentials, SSEP (4.996), and brainstem auditory evoked potentials, BAEP (2.8{\%}). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1{\%}) and spinal cord, imaging (cervical cord n = 57; 52.3{\%}; thoracic cord n = 32; 29.4{\%}) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. Conclusions: Patients and clinicians may be reassured that peristent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.",
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T1 - Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence

AU - Boster, A.

AU - Caon, C.

AU - Perumal, J.

AU - Hreha, S.

AU - Zabad, Rana K

AU - Zak, I.

AU - Tselis, A.

AU - Lisak, R.

AU - Khan, Omar

PY - 2008/7/1

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N2 - Background: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnosis investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assements and persistent neurologic symptoms. Methods: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. Results: All 143 patients had normal initial examinations, brain MRl scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervicial cord n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.996), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord, imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. Conclusions: Patients and clinicians may be reassured that peristent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.

AB - Background: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnosis investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assements and persistent neurologic symptoms. Methods: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. Results: All 143 patients had normal initial examinations, brain MRl scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervicial cord n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.996), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord, imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. Conclusions: Patients and clinicians may be reassured that peristent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.

KW - CNS symptoms

KW - Demyelinating disease

KW - Diagnostic criteria

KW - Multiple sclerosis

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