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

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

C Caon

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

J Perumal

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

S Hreha

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

R Zabad

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; Department of Clinical Neurosciences, Calgary, Canada

I Zak

The Detroit Medical Center, Detroit, USA; Department of Radiology, Wayne State University School of Medicine, Detroit, USA

A Tselis

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

R Lisak

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA

O Khan

Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School Medicine, Detroit, USA; The Detroit Medical Center, Detroit, USA, okhan{at}med.wayne.edu

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 diagnostic investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assessments 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 MRI scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervical 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 (4.9%), 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 persistent 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.

Key Words: multiple sclerosis • CNS symptoms • demyelinating disease • diagnostic criteria

This version was published on July 1, 2008

Multiple Sclerosis, Vol. 14, No. 6, 804-808 (2008)
DOI: 10.1177/1352458507088156


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