Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence
被引:9
作者:
Boster, A.
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Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Boster, A.
[1
,2
]
Caon, C.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Caon, C.
[1
,2
]
Perumal, J.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Perumal, J.
[1
,2
]
Hreha, S.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Hreha, S.
[1
,2
]
Zabad, R.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Dept Clin Neurosci, Calgary, AB, CanadaWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Zabad, R.
[1
,3
]
Zak, I.
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机构:
Detroit Med Ctr, Detroit, MI USA
Wayne State Univ, Sch Med, Dept Radiol, Detroit, MI 48201 USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Zak, I.
[2
,4
]
Tselis, A.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Tselis, A.
[1
,2
]
Lisak, R.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Lisak, R.
[1
,2
]
Khan, O.
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机构:
Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Detroit Med Ctr, Detroit, MI USAWayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
Khan, O.
[1
,2
]
机构:
[1] Wayne State Univ, Sch Med, Dept Neurol, Multiple Sclerosis Clin Res Ctr, Detroit, MI 48201 USA
[2] Detroit Med Ctr, Detroit, MI USA
[3] Dept Clin Neurosci, Calgary, AB, Canada
[4] Wayne State Univ, Sch Med, Dept Radiol, Detroit, MI 48201 USA
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.