Multiple Sclerosis Diagnostic Criteria [Neurologist Explains]
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- čas přidán 19. 04. 2022
- This video explains the 2017 Revised McDonald diagnostic criteria for multiple sclerosis. I am happy to field questions in the comments as long as they are not phrased to refer to your diagnosis.
Diagnostic criteria from the national MS Society: nmsscdn.azureedge.net/Nationa...
CMSC MRI guidelines: cdn.ymaws.com/mscare.site-ym....
Comment or ask questions below! I would be happy to answer!
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My book "Resilience in the Face of Multiple Sclerosis" on Amazon: www.amazon.com/dp/B07WP7H5LK
Dr. Brandon Beaber is a board-certified neurologist with subspecialty training in multiple sclerosis and other immunological diseases of the nervous system. He is a partner in the Southern California Permanente Medical Group and practices in Downey, California (South Los Angeles). He has several publications on MS epidemiology and has participated in clinical trials for MS therapeutics. You can follow him on twitter @Brandon_Beaber where he regularly posts about MS news and research.
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he video material by Dr. Brandon Beaber is general educational material on health conditions and is not intended to be used by viewers to diagnose or treat any individual's medical condition. Specifically, this material is not a substitute for individualized diagnostic and treatment advice by a qualified medical/health practitioner, licensed in your jurisdiction, who has access to the relevant information available from diagnostic testing, medical interviews, and a physical examination. To the extent that Dr. Beaber endorses any lifestyle change, behavioral intervention, or supplements, the viewer should consult with a qualified healthcare professional to determine the safety and efficacy of the intervention in light of their individualized information. - Věda a technologie
Interesting video! I was diagnosed with MS in 2000, I was only a 20 years young man. The spinal tap part, I felt that throughout my whole body *shrugs* I remember referring to the guy performing it as "the temp" 😂 he was instructed how to perform it and bumped against nerves and it's the most uncomfortable feeling ever.
I remember hearing about some people only having one episode and that's it. But sadly, after the MRI the doctor informed me that I had already had a few. Long story short I was hospitalised for 2 weeks with stuttering speech, poor balance, loss of sensation half side of my body, sensitive hearing etc. I started medication a few months later. This was the weirdest part to me, as they weren't allowed to decide for me which brand/type to get, only which one they had the most experience with. I have forgotten the name, but remember the side effects put me off, so I went for a newer one called Copaxone.
Interesting detail around 2005, the only change in my life was that I went vegan and coincidentally, I have not had any symtoms since. And I stopped taking the meds around the same time. I remember asking my neurologist about any connection between diet and MS and he just smiled. I brought this up with another neurologist and he was more open to it but didn't think it had any serious "healing effect". I have since read about a connection between animal protein and MS, and heard about several other people getting better after adopting a plant based diet, but these are just personal anecdotes. Still interesting. Whatever changed, I'm lucky I'm in good health at 40+, out running each and every day. Thinking back to when I had to support myself using a crutch and a friend downtown asked me if I was drunk. Or the time I woke up and couldn't speak properly... or strum the guitar. Feels like a different life. I was lucky. I should get another scan done at some point. Well that's my story.
Look up BDNF: factor, this it probably why a plant based diet works for treatment, but beware, as vitamin D take years to reduce stores, I would look at introducing meat back in to your diet, but very lean meat only. To keep your vit D from depleting.
Gives me hope hearing your story, thank you. 😊
Pppppo
@@draxthedarkreaper "...vitamin D take years to reduce stores..." ?? stores? What does that mean? I wish people would proof-read what they type!
It means your body keeps vitamin D in larger quantities over a longer period of time. So it takes a long time for it to deplete. Thus taking a long time to see the negative affects. It also works the other way around. Takes a while to see the positive recovery of getting your vitamin D back.@@Steevee14
Wow! What a great video! It's great to be able to see MRI's that can lead to a diagnosis, as well as touching on other diagnosis options that may crop up.
While investigating what ER drs thought was a 'cervical spine strain' that resulted in numbness of the right side of my face extending down the entirety of my right arm/hand, I was sent to a sports med dr. At that appt, I asked if I might have MS, because I never sustained any injury to explain these symptoms. Since she planned to do an MRI anyway, she agreed to check for MS.
As suspected, my MRI showed several lesions consistent with MS. A neuro confirmed diagnosis when I explained I had a vision 'issue' (optic neuritis) in my left eye 3 years prior that I never followed up on because it resolved after a week or two. Overall, I feel I was pretty lucky to be diagnosed relatively quickly. Thank you for the video!
Thanks for this. I appreciate the value in not misdiagnosing other ailments as MS, but never having it considered was frustrating. Decades is right. There was a maybe (no testing no treatment and) 10-15 yr pass, possibly not conclusive (MRI no treatment) another 10-12 yr pass, Finally an absolutely and only needed the MRI for proof positive (treatment).
This was so well explained, thank you. I often wonder if my MS diagnosis is correct since I had ON 10 years ago and nothing since, but your video helps convince me again that the diagnosis is correct and I have to keep going with my therapy.
I have 20+ lesions (but unchanged since the first MRI in 2013), positive iGg and borderline evoked potentials. So I couldn't have been a better example of MS at start, but a decade of no change sometimes makes me start doubting. Your videos help put me back to the right track. Thank you, Dr. Beaber.
Im 35 and started neurology with blood work after the initial exam. Within days they called me about my B12 results. I was scheduled for my first (monthly) (Cyanocobalamin) shot within 3 days. I will have to do them monthly for the rest of my life as I don't have the ability to process or absorb it.
I had already been diagnosed with glaucoma and unexplained peripheral darkening 2 years prior. My first official neurology ordered MRIs conducted on 4/18/23 only took 2 days to come back and sure enough I have multiple white matter lesions in the frontal lobe no bigger than 3mm right now. 2 lesions found on the spinal cord, spinal stenosis, multilevel disc disease, spurrs and bulging discs. Multiple scattered lesions were discovered throughout my neck, on my thryroid and cysts on my lymph nodes. Im missing quite a bit but they absolutely could have caught this sooner! 3 years it took! I have more MRIs with contrast dye on May 16th. The neurologist are absolutely taking it seriously as of now. I haven't slept much in 2 days this spinal pain is KILLING ME. Right hand losing total sensation/stiff no movement and so painful!!! 😢
Dont stop fighting for yourself!!
I sincerely hope you're feeling better now. ❤
This was very helpful -- although I keep hoping I was misdiagnosed, this very clearly makes me understand how I was diagnosed. Thank you!
Thank you Doctor! Very helpful - I’ll be sharing this with family and friends that ask me about my diagnosis. Glad to have record of my LP as it appears to be something many studies require in order to participate. I’m unclear on why that is as my MRI and physical condition would appear to be sufficient
So glad I found this information as it exactly addressed some of the issues I am having regarding diagnosis and now I understand my situation so much better. The best part is now I can have an informed discussion with my neurologist later this month and also know what to look for in the future. You are awesome!
I'm glad it helped Ann.
@@DrBrandonBeabertudr😊
I can't believe for the life of me that I missed this video Dr Brandon, as always you are brilliant my friend.
Thanks
Thank you so much for posting this both very detailed but also very accessible information! I feel much more informed going into my evaluation of my "ms probable" mri with the neurologist. As someone with a just a single clinical event, it gives me a much better idea of what he will be looking for!
I'm glad it was helpful Renae. The diagnostic criteria are very obtuse.
Thank you so much for your excellent video!
My MRIs are clear of lesions, but I definitely have punch of symptoms and it was good to hear that there is also other possible diagnosis for "weakness on other side of the body".
It is hard to advocate for oneself when one does not have information that clear MRI does not mean that I do not have some neurological condition going on. Doctors are trying to convince me that all my symptoms are only in my head. Hah, probably they are 😅 but NOT in a way they mean it 😄
This video was well made and it was easy to follow up without any previous medical knowledge. You are doing a good job! 👌
I would love to see a video on nothing but the following topic: the subtle (or not so subtle) differences between MRI brain lesions and lesions commonly seen in the general population that end up in that UBO category. The lesions caused by migraine, in particular, look really "tricky" to my untrained eye -- to my eye, they do look like cortical MS lesions, and I'm curious how one is able to tell the difference (and with what level of certainty ... or is there a large overlap in the morphologies and locations of MS and migraine/UBO lesions?)
Thanks for the video suggestion. This is a good idea.
I have four neurologist looking at my first MRI after having migraine for years. I also have had numbness, double vision and left eye pain, and tremors for years but thought it was due to my anemia and low potassium which I was told for years. I also have a cyst on my pituitary gland. All my lesions are non enhancing and many with white matter and I’m 46 years old and no head injury . Any advice?
@@DrBrandonBeaberhas it been made
@@JedidontcheatIf you have four neurologists looking at your MRI , I would help you get all the advise you need.
I had severe migraine attacks for years. Since my first MS symptoms appeared, I've not had any. No idea if it's the ms/symptoms like the lesions on my brain or just a coincidence. My brain doctor it's not the first time he's heared that. Who knows?! Lol
Thanks for this video Dr. Beaber! Excellent explanation of the criteria and other conditions that can cause lesions and symptoms.
Thanks Vicky. It's a bit technical, but I figured people want to know these things.
@@DrBrandonBeaber
We DO.
Thank you for this video & channel. I've been struggling with health issues for years and trying to advocate for myself without trying to self diagnose. I was starting to wonder if MS could be a possibility and with the info in this video I can understand why this has never been mentioned to me before. I need to keep advocating for myself to get to the root of my symptoms.
I was diagnosed with CIS in 2014 after having optic neuritis and a few brain lesions on MRI. I was told there was around a 65% chance that I would develop MS. I had several follow-up MRI’s with increasing intervals. In 2019, at the 5-year mark, new lesions were found and I was diagnosed.
Thank you for your videos and efforts dr. Beaber, much appreciated!
How are you doing today? 😊
@@InesBrandling I am doing very well :-) After my diagnosis I had another MRI a few months later and a new lesion was found. I started medication (Tecfidera) after that. No new lesions since then, I have been lucky! Hope you are also doing well.
Love your videos thank you! Grateful mother
Very good video and content, doctor! Thank you so much! I would love to see more topics about the ddx of MS (like neurosarcoidosis you just mentioned).
I believe you helped bridge the gap between my neurologist and I. I have been looking for more definitive proof of MS. I’ve been told I have MS but I was skeptical and still worried it’s worse than MS. But I now understand how I was giving the diagnosis of MS. I have one brain lesion, 4Obands and many episodes/moments/flare-ups. I have lost use of my right leg. Lost feeling and reflexes in right leg. And it has been numb since. I would love to be able to communicate with you in a private way if possible. I did subscribe. My neurologist is sending me to a specialist now. I think he is frustrated with my denial of MS but he decided to transfer me when I showed him the many videos of aggressive fasciculations I’ve been encountering lately. Thanks and again this was very helpful
Hi hope you are getting answers and help you need. Curious about the faciculations, (I've been having many faciculations in face and arm along with numbness and tingling , I see neurologist at end of month) where are your occurring if you don't mind me asking. Thanks
Tomorrow is my neurology exam and i was having hard time understanding time and space dissemination u made it so easy
Awesome. Thanks and good luck.
I was pretty lucky, I guess. I woke up one morning while in the Navy (stationed at Navy Band San Diego) with slurred speech and right sided weakness. Went to Balboa Naval Hospital they told me to take Christmas leave (this was just before Christmas) and come back if it got worse. I took the leave and it got worse. Went back and was admitted. After a few days and the required tests (CT scan, MRI, lumbar puncture) I was diagnosed with "probable MS" (this was in 93 when i was 22). So all in all pretty fast. The only symptoms I had before then was 2 occasions when I had SEVERE chills accompanied by fever for half a day with difficulty walking that resolved very quickly. I thought it might be food poisoning.
Thank you for another great video, and I bought one of your books today on Amazon. May I suggest a video topic? How about common and uncommon ways that MS attacks/episodes present themselves. For example, my husband lost hearing in one ear over night. (He recovered a little hearing in that ear over time but not much.) I hadn't heard of that before. Or have you ever seen something that looked a *lot* like a stroke but turned out to be a MS episode that responded to steroids?
Hearing loss is in fact a very rare multiple sclerosis relapse symptom. I have had patients with hearing loss as part of a brainstem relapse but not in isolation. Dr. Boster has a video on rare and unusual symptoms in MS: czcams.com/video/HBEk7Vd9di4/video.html
Whats the major difference between ALS and MS Doctor? @DrBrandonBeaber
Thank you . Great explanantion . Best regards.
Dr. Beaber,
You are very helpful, Thank you.
Understanding your explanation of McDonald criteria, is the McDonald criteria (below) still subjected to a lumbar puncher or does below satisfy the McDonald criteria in its entirety?
- There is mild to moderate periventricular and subcortical white matter FLAIR and T2
hyperintensity and there are linear pericallosal foci of signal abnormality oriented orthogonal to
the long axis of the corpus callosum. In addition there is a questionable focus of signal
abnormality within the corpus callosum itself.
Thank you so much for this very helpful video. I have a diagnosis of Autonomic Neuropathy, but am getting numb patches and staggering, so MS is now being considered. I've got an MRI this coming week. Please do you have a video on the differential diagnosis between AN and MS? I've only just discovered you! With best wishes from Ruth XXXXXX
I was dg last summer. I had only two lesions on MR, one of them was active and my right side of face was numb. My csf was negativ for oligoclonal bands. Also, I have never had before any simptoms in my life. I started with Tecfidera a month after dg.
Query for you: What was the purpose of the spinal tap if the diagnosis was clear even with a negative result? Was there another possible diagnosis which could be evaluated by spinal tap?
@@DrBrandonBeaber I was told they wanted to eliminate all possible diagnosis. At the same time I received pulse therapy which did not work. My face was still numb, but the symptoms went away after 3 weeks. I had an active lesion on the pons. Now, I feel healthy, but I'm aware that MS is unpredictable...
It took me 10 years and four different neurologist. I was offered Valium and told to chill out by one. One ER doctor gave me narcotics …. Crazy stuff. Many lost years when I could have been on a DMT.
I have a very similar story. I was 11 years between first but of optic neuritis (they didn't do an MRI, just said it will go away on its own eventually) and the second which ultimately lead to my diagnosis. I was unable to walk unassisted due to loss of balance and coordination and the ED doctor told me I was making it up. I told him "I was a gymnast, I have excellent balance yet can't walk without help. Also, I am a medical student, I'm not oblivious to what's going on". Then I showed him my abnormal eye movements. He completely changed his tune after that and sent me to a neuro-ophthalmologist and the tests and diagnosis followed. BUT if I had been follow up on the first time I may not have permanent changes now, it's tough to think about.
@@KaitCervi 💗
Thank you for the veido, how would you treat typical demyelinating Syndromes?
Thanks for your videos Dr. Beaber, both informative and entertaining. I am starting my neurology clerkship next week and I am very interested in the field!
Thanks. Perhaps I will see you a conference sometime in the future. I may attend the Fall AAN conference if it is in person.
This is a great video Dr Bieber. Thank you. Could you also do some more in-depth videos on looking at our MRIs? It helps greatly when I'm looking at my own CD collection.
I will definitely do some more videos on MRI scans going forward.
Love that you call it CD collection. :D I have one, too...
Great video. I am still unsure whether I have MS, but listening to the criteria, I think I probably do. Four years ago, I was told by two different MS neurologists in Sydney, Australia, that I definitely did not have MS. Why? (Too old 58 at the time, my lesions were in wrong part of brain for MS, no spinal cord lesions, no oligoclonal bands but CSF protein was four times the normal range, no motor disability, although lots of sensory effects such as left-sided paraesthesia, fatigue, numbness etc.). I fully recovered and enjoyed two years of perfect health with no treatment. Running 5kg, doing resistance training and yoga etc. Then, my symptoms (again, left sided paraesthesia - left arm , left leg, left side of face and extreme fatigue) returned this year. Had another spine and brain MRI. Interestingly, no change from two years ago, but because I have a relapse in symptoms, I have now been diagnosed by a different neurologist with relapsing remitting MS.She wants to start me on Kesimpta. I am terrified of going on it at age 61 just in case I don’t have MS, and my B lymphocytes get depleted and I end up contracting respiratory tract and urinary infections etc. When you’ve been told you definitely don’t have MS by two different neurologists and then two years later, you’re told you do have it, it’s a bit hard to get your head around. I wish I could send you my brain scans and CSF and blood results and letters from my initial neurologist to my GP and get you to do a thorough review of my case. I live in Sydney, Australia, so that’s probably not possible, but let me know whether you’d be willing to consider it. The parting comment from my neurologist of two years ago was that “if you do have MS, it’s a very atypical form!” What am I supposed to make of that? 😢
I can't help you personally, but I wish you good look.
@@DrBrandonBeaber I figured that would be the case, but thank you for replying. I wonder though, if you could make a video addressing what is likely to happen to a person who doesn’t actually have MS, but who starts a DMT? This must be the reality for some poor patients.
@@Wendy-nv5cd This happens all the time. Here is an article about one of my patients who was misdiagnosed with MS and took disease modifying therapy for many years: www.nytimes.com/2019/05/01/magazine/symptoms-multiple-sclerosis-diagnosis.html
Fantastic video Dr!! I had a spinal tap in 2008 as part of my diagnosis. Not a fun test!
I can only imagine. Luckily, we do them less and less often. Perhaps with advances in MRI (and the ventral vein sign), they will be a thing of the past (for multiple sclerosis at least).
Mine came back negative and Im still diagnosed with it
@@cloudy.w.no.chances that can happen, which is why a spinal tap alone can't be used to diagnose MS.
@@dmphax yeah it’s just weird cause I have a spinal lesion so I thought it would’ve been picked up. My aunt has MS too and that’s how she got diagnosed and she has 2 spinal lesions and no brain lesion while I have 4.
@@cloudy.w.no.chances what shows up in spinal fluid are Oglicogonal bands. They're bands of immunoglobulins, so different than lesions.
I got a headache in December(still do) and ended up getting an MRI which showed over 20 WMLs, one wast contrast enhancing on the next exam. CSF had increased leukocytes and over 10 oligoclonal bands. VEP showed slower signal on my right eye, and OCT showed thinning of the optic nerve but my vision was good. Ive had subjective numbness in my right arm and leg but no objective findings on physical exams. Most of my symptoms are headache and fatigue.
So now after many months my neurologist says I have radiologically isolated syndrome. Like what? Its also in my CSF and optic nerve so how is it radiologically isolated? They said they decided to start treating me as if I had ms, with Rituximab, but wouldn't actually give the MS diagnosis.
They've basically excluded every other diagnosis so I don't see how it can not be MS. But I am happy they are going to give me treatment, and that I don't have to wait around until I get more brain damage...
Really baffled at how hard it is to get this diagnosis.
Been diagnosed with RRMS but have no idea what a relapse is and have never experienced one. Couple more lesions on a follow up MRI. Now on ocrevus but next time I speak to my neurologist I may ask if its PPMS and not RRMS
I would like to hear something on trigeminal neurolgia
Hi, I was diagnosed with MS four years ago. I had symptoms 10 days before the MRI. the MRI showed two non enhancing lesions in the brain and one in the spine. The bands were positive. They Diagnosed me with MS.
I’ve never had any symptoms before this relapse.
I’m wondering about the relapse. Since it occurred 10 days before the MRI should have the lesions been enhanced?
I was told the enhancement last for at least 2 weeks.
I’m on the drug Tysabri and have not had any activity thank g-d since.
Just wondering if there is room for a misdiagnosis in my situation?
My spinal tap came back negative when I possibly had a spinal lesion (my original neurologist didn’t do a spinal MRI at my first symptom - numbness) i have 4 brain lesions but looking at all these pictures, nothing looks like my images and nothing moved between all of them. Ever since I started Dimethyl fumarate I been having heavy headaches or migraines, not sure which going to change to Tysabri soon.
Very nice video ... Referring to Spinal tap ... OC band number isn't that used as well ? Will the criteria be altered to include central vein sign?
The number of bands is not part of the criteria. Having 2 or more bands in the cerebrospinal fluid not corresponding to bands in the blood is considered to be consistent with MS. Perhaps in the future, the central vein sign will become part of the criteria.
I have heard that there gonna be a blood test instead of spinal test in future to confirm ms
Great video
Thanks
My 18-year old daughter had optic neuritis in May 2020 and an MRI in June 2020. MRI came back clear. Repeat brain MRI in Sep 2021 revealed "Single non-enhancing patchy area of T2/FLAIR hyperintense signal within the periventricular white matter on the left, although somewhat atypical, given the patient's age and history, demyelination is favored. Consider further MRI imaging of the cervical and thoracic spine." Neuro did not do a cervical or thoracic, did not do a spinal tap. My daughter was told she has MS and has been on Vumerity since Oct. Now I'm wondering if she is in the category of "high risk" of developing MS as opposed to actually having it? She just had another brain MRI and goes tomorrow for the results.
What was said? And I’m sorry
THank you for asking. Her follow-up MRI had no new lesions. She still has the diagnosis of MS, has had no relapses, no symptoms, and continues to take Vumerity. She also had another follow-up MRI since I last posted it, no evidence of disease progression. This is all very typical for RRMS and she is continuing treatment. She's 21 now and going strong in college :)
@@forgetthis2607
Thank you, Dr. Beaber! Is positive IgG ratio without oligoclonal bands & everything else within normals considered positive CSF finding for MS dx?
For the purposes of the diagnostic criteria, they just list oligoclonal bands in the cerebrospinal fluid but not in the serum (blood). However, elevated IgG synthesis and elevated IgG index are also associated with multiple sclerosis.
@@DrBrandonBeaber Thank you!
Love your videos and a a Practitioner, I find them so informative except in my case. I have seen two different neurologist , one says MS, and now wants to put me on Kisempta , the other says doesn’t look like MS. What are options that I have. I am on Plegridy current , and not a fan of switching. However, if one were to be told two different things. What would be the next step.,
Suggestion for a future video, what is the role of HRT in the management of MS in menopausal women?
Thanks for the suggestion. There is some good research from UCLA about estriol as potentially beneficial in MS.
Helo. How are you? Its not related wirh the video but i whant to ask you for your help: I want to ask you a question, therefore: a good friend of mine who has MS like me has been suffering from a very painful problem for a few months, which he thought was trigeminal neuralgia, but when he went to treat it he was told that it is not so. He also went to many dentists and was told that he had no problems with his teeth. He is currently on Aubagio, he was on Betaseron before and was changed because he had active lesions. He recently had an MRI and had active lesions again. What do you think he would have? PS: it hurts to say that someone cut him alive with a knife.
9:22
If previous two attack were optic neuritis and transverse myelitis, do I need the additional clinical attack to be in a site other than optic nerve and spinal cord? If yes, why?
Or 2 attacks here denotes attack at same site?
Will MS lesions on the brain typically show during MRI with no contrast?
I complained of double/foggy vision GP corrected refraction and a year later diagnosed with diabetes. Then vision kind of got better but developed tremors. GP referred me to a Neuro, who tapped hammer, torch, tongue out etc, referred me to MRI and diagnosed “Demyelination” (me like De-mye-what 😀) and so the game started
So does that mean u have ms
@@denastone5483 yes, from 2004
@@ragub6 thanks I've just been diagnosed with demyelination. Been having symtoms for 5 year .vision problems weakness fatigue pins needles .waiting on neuro appointment. I just want answers thanks for answering my question
@@denastone5483 Wish you the best.
So in light of possible miss diagnosis/rare co diagnosis ... someone who has Dawson fingers and lisons touching the corpus Collosum (picket fence sign) but then get a spinal lison that's not typical of ms as it's in the center of the cord and tin and long is it possible to have have a miss diagnosis with the top two lisons .... and is it possible to have a co diagnosis with ms ......
I got diagnosed with MS my second visit
I was diagnosed after an MRI to look at my sinus. She showed me the lesions--about 5 or 6, so after watching this video I am wondering if they actually can go away? I was told I need to be seen for this every 2 years & they ask you to repeat things they've said earlier, like a cognitive test.
I was diagnosed in Jan. 2016 and I will finally have job based medical care this coming year, so it has been 9 years.
I hope they dont want to do a sinal tap cuz I had one for a c-section and ended up with a 'spinal headache', stuck in hospital for 7 days before someone figured out doing a 'blood patch' was how to fix that.
Will a new physician be able to get my previous MRI & diagnosis from another doctor out of state from 9 years ago?
I'm from Bangladesh. Recently I have diagnosed Spinal MS. My symptoms are excess tight pelvic floor muscle, chronic constipation, urination difficulty, weakness in both legs. In Bangladesh, there are limited MS treatment. Will you please help me?
Hello Doctor Beaber,
Thank you for your informative video. Understanding this is an old video and you may not reply, I do have two questions:
1. Can a negative brain MRI without contrast rule rule out MS (or at least make it very unlikely). Or, does the MRI need contrast to spot MS lesions?
2. Please review the following hypothetical and give your assessment as to whether these symptoms seem consistent with an MS diagnosis. On a Tuesday, patient has sore left forearm with shooting electrical pain and tingling in fingers (similar to carpal tunnel). Within 48 hours, the same sensation occurs in left leg and toes. Within an additional 48 hours, those same sensations affect the right arm/hand and right leg/foot. Ultimately the shooting pain affected all four extremities, male genitalia, the neck and scalp. Eye twitching is also present (but had been present in the months prior). No cognitive symptoms. Patient recently finished 3 week course of doxycycline for Lyme disease (could Lyme be the cause rather than MS? Patient’s western blot had positive IgG (though i believe MS IgG is in reference to spinal fluid and not blood).
Thank you again for your video and your response.
All the best.
In the overwhelming majority of people with MS, an MRI of the brain without contrast will show lesions typical of the condition. No comment on question #2. Assessing whether or no symptoms could be related to MS requires a detailed history and examination.
Thank you for your prompt response. I appreciate your help. Take good care.@@DrBrandonBeaber
This is an older video so you may not reply. How common is muscle twitching/fasicilulations combined with pins and needles sensation in the limbs, s symptom of MS? Different MS sources seem to conflict as to whether muscle twitches (all over the body in different muscle groups) are a symptom of MS. Some websites say this is rarely a symptom of MS and is more characteristic of something like ALS, others list it as a symptom. I know the tingling/numbness/pins and needles type sensations can be symptoms, but what about muscle fasciculations? (when I say fasciculations I am talking about the kind of rapid transitory "eyelid twitch" you get when you are tired, but experienced in the biceps, triceps, calf, thigh and forearms). Thank you for any input.
numbness/tingling is a common MS symptom. Fasciculations come from the motor neurons and are generally not associated with MS. It should be noted that fasciculations and eyelid twitching are extremely common and not necessarily associated with a neurological disease.
How are you doing ?
@@RobdeKlerk-qg6lc Hi, not sure if your comment was specifically for me but I had many many tests and scans, no sign of MS. What did show up was chronically low Vitamin D. I started a supplement and about 70% of the muscle twitching is gone but I still experience it in my biceps and feet sometimes. Much better though. Pins and needles a bit better though not completely gone.
@LouScotland1976 Yes , you had all my symptoms sir...thank you for your reaction..
Do B lymphocyte-depleting DMTs such as Kesimpta work as effectively in oligoclonal band negative MS patients as they do in patients with oligoclonal, bands?
How often do MS lesions in the spinal cord get mis diagnosed as some other type of lesion, Spinal epidural lipomatosis for example?
One question:
Two attack of painful loss of vision and both episodes consulted with doctor who found optic neuritis. Does this meet dissemination in space?
It is common place for a physician to receive a patient with a diagnosis confirmed elsewhere When should a doctor take a new look to see if the diagnosis is correct? With only brain and spinal column MRIs, is there a “magic”NUMBER of lesions/locations appearance for confirmation of MS?
I would never accept an outside diagnosis of MS without reviewing the history with the patient and their MRI scans. The specific diagnostic criteria are based on clinical, MRI, and [in some cases] CSF findings as explained in this video.
Ive had chronic dizziness for over 25 years which started after 3 consecutive years of labrynithitis. I have had ME for 30 years or so i gave been told. I have had tendonitis for 10 years. I now have a numb back and pins and needles in my back several times a day. I do have stress due to a family situation over the last 7 months so been told it is probably the cause. If i see a doctor i am usually told my symptoms are due to stress or ME.
What is tumefactive MS? My son had 2 episodes of Optic Neuritis 2000, 2005 and then on 2010 the left side of his body got num, the MRI was described as Tumefactive MS.
At that time he also was Dx with bilateral jugular stenosis with blood reflux=CCSVI. He was treated with a balloon angioplasty and 9 months of Tysabry. Since 2010, he has remained stable without DMDs Now the neurologist wants him to start with ocrevous. But we are afraid of it. What is your opinion please?
I can't give you personal advice here. "Tumefactive" MS generally refers to MS with a large tumor-like lesion. Sometimes, people with tumefactive MS have a single dramatic attack and do not have relapses. In other cases, they go on to develop more typical MS. CCSVI is a controversial topic discussed here czcams.com/video/sqoK9BkI6g0/video.html
Is it possible that someone has a MS even though MRI of brain and cervical spine comes out normal?
Could bone marrow lesions on a lumbar spine MRI be part of an MS diagnosis?
No. This would be unrelated.
Do you have any vids on MG?? This was excellent.
Trying to figure out what autoimmune disease I have. They're having me wait 4!! months! for second part of ncs.
Already been waiting a year, to get this ball rolling.
Id look myself, but I can't see! Damn dbl vision.
The lab orders were for MG and those tests.
May be that, may be MS??
I know, I know....
Don't Google this stuff.
But man oh man.
I'm wasting away.
My muscles are seriously deteriorating.
And rapidly.
I feel like it's getting to be an SOS shituation.😬
We have to be our own advocate!!👊💪
You're awesome btw! 😁🤭😘
nice !
Thanks
Hello DR,
Just a quick question. Can I get your opinion on HSCT ?
I have a playlist on this topic: czcams.com/video/jNgoxJTgQJc/video.html
Thanks Dr,
Stay safe
Have you already done a neurosarcoidosis video?
I have not, but thanks for the suggestion.
I would quite like to see such a video, as well!
Are MRI scans actually effective? I've had several concussions. And was in the middle of a 2 week long severe migraine and the MRI was fine🙃
I had a brain MRI it showed non specific white matter in per ventricular and subcortical bilaterally. I also did a spinal tap and spine MRI and both came back negative. I am really confused don’t know what I have. Could you please reply to me back 😔
Same, all was told was the lessons not Patterson for ms....yet have numb tingling face, arms and feet ..blurred vision plus trouble swallowing , remembering words etc ,.but was told not ms ..end of !
I have frontal lobe shrinkage age 54 female and ton of symptoms of Ms over 14 years. Could this be ms
So if it goes away sometimes it is curable.
Years and years with symptoms and neurologist who reduce to test patient and instead keep think the patient needt to go to psychiatrist instead, because of the patient having depression and anxiety as well.
"The correct diagnosis is 3/4 the remedy"
This is the exact reason I am so insistent on getting tests done and why I bother my neurologist so much. I've had a range of symptoms for 1.5 years and I just want answers. I know its not stress, I know its not my plant-based diet, I know its not my sedentary lifestyle. It might not be MS but it is probably a neurological issue.
What would diffuse demyelination on cervix and thoracic mean ?
This could refer to multiple sclerosis lesions within the cervical and thoracic spine, but I can't comment on your specific situation.
@@DrBrandonBeaber it only says diffuse demyelination on cervix and thoracic . I had hsct went to Russia . I always had normal mri with ms symptoms. Then I went to Russia and they would test first before hsct and that’s what he saw in spine . But no lesions ?
I was dx'ed right away, Oct 2019. Age 37 F, optic neuritis as presenting symptom. Have a few non-remarkable lesions in my brain, and a 2 on my spine (but these have gone away per a followup MRI this year) I don't really understand how they go away... any insight helpful. Also apparently had oligoclonal band in my spinal tap. I take Truxima 1x/yr. I have ZERO symptoms, in fact feel healthier than ever. Would it be worth it to have another neuro look at this and see if I was misdiagnosed, or is it just that the Truxima is working? I appreciate any insight.
Interested to know the doctor's answer too
Four years here.
Can lesions be non-specific in the juxtacortical?
Yes. Sometimes. "u-fiber" lesions are more specific to multiple sclerosis.
@@DrBrandonBeaber thank you for answering, I had a MRI done for double vision. The report said periventricular lesions (making contact) and juxtacortical lesions, the radiologist even put the 2017 McDonald criteria on the report but said “indeterminate” for MS vs micro vascular ischemic disease. So my doctor had a board certified neurologist look at it…determined it was “non specific” lesions her opinion not MS. But I am not sure whether to get a second opinion or not. All the research I have done says ischemic lesions are not usually a in the juxtacortical region but are usually subcortical. So it’s confusing. But thank you again for your knowledge on the matter. ☺️ I know you can only general questions, your answer helped. 👍
I had a brain mri in 2021 to investigate my pituitary gland. Whilst getting that mri the radiologist noted an incidental finding that there were numerous white matter lesions suspicious of demyelinating disease. I thought nothing of it as my consultant asked me was i having symptoms such as numbness or tingling and i told him i wasnt so he said he thought they may be mri artifacts. I was having brain fog and problem's with concentration for a while prior to seeing him but didnt think that had any relevancy to this.
Anyway i had a follow-up mri of my brain and whole spine done 2 weeks ago with contrast. I just got the report a few days ago and it confirms these lesions. Im no neurologist so i cant understand it that well but there are a number of lesions all in my brain. My spine was lesion free. It did say once the contrast was administered the lesions could not be seen. Symptom wise i still have the brain fog and some trouble concentrating and also my memory is definitely not as good aa it used to be, but nothing at all motor skills wise. As far as i know i am being scheduled for a lumbar puncture soon. Im only a 33 year old man and im worried what the future will be 😢
I can't comment on your specific situation, but this video on Radiologically Isolated Syndrome may be of interest to you: czcams.com/video/GyxUPJ7mZbY/video.html MRI lesions can also be misinterpreted as explained in this video: czcams.com/video/GNnba5HVvdY/video.html
Thanks Dr. The report mentions the lesions are in the periventricular regions bilaterally and in the frontal and partiel lobes and most of them perpendicular to corpus callosum. No lesion seen in cerebellum or brainstem.
No hydrocephalus or midline displacement.
Non-enlarged pituitary fossa. If you can understand that? I worry just that I'm gonna drop dead or something 😥 I live in Ireland and our health care is slow to say the least so I could be waiting a while to see a neurologist. I will take a watch of your video thank you.
I Have a unusual case that I am still trying to find out what I . 8 years ago some attack with numbness and tremor lasted a month went away mri normal. Went on for years with odd feeling I wasn’t normal legs very stiff the muscles . Arms would feel weak then get better . Many mri over the years all normal . Last year it was very seldom to monthly I would feel one side of my body would get nerve damage my leg would be heavy and hand would be hard to open . Next few days a little better then the next side . Now daily waking up and everyday one side is affected . I can feel it in my spinal cord . Feels like shocks and heat down my spine . Little worse each week now . Had a mri in early Aug all normal . Both sides are affected I am 54 years old . Not a doctor but I have always believed I had ms but it was not bad enough for anyone to see and it was little things and then they got Better . It’s like a tap and now tap went from very little to full blast . Any suggestions would be helpful I have been to ms clinic seen many neurologist and they can’t figure it out and said ms as it’s always on mri they never seen anyone with normal mri . Getting bad by the day . Any suggestions??? Desperate
There is no way I can give you personal advice. In general, MS with normal MRI scans is very rare.
@@DrBrandonBeaber I know I can’t ask for advise but I was looking to see if you have ever seen a case like mine then eventually mri became positive for ms ? That’s what doctors says it’s rare but rare to me mean low percentage but not out of the question? Could you be diagnosed with exam and lumbar Punture ?
@@lisaelliott5135 I do have a patient with primary progressive multiple sclerosis who initially had a completely normal MRI of the brain, but this is extremely uncommon.
Hi Dr. how I connect you to discuss my disease
Sorry, but I would not be able to help you personally.
How fast does Primary progressive ms progress?
It varies tremendously, and I have patients with progressive MS with relatively low disability over many years. Here is a video looking at data from MS Base looking at progressive MS prognosis: czcams.com/video/znLKyCMtqsw/video.html
@@DrBrandonBeaber thanks a lot!
Does having epilepsy make one more at risk for MS?
People with MS have an increased risk of epilepsy (~2-5% risk). If someone has epilepsy for another reason, it would not increase future risk of MS (presuming the cause of the initial seizure is not undiagnosed MS).
@@DrBrandonBeaber Thank you.
What if you are not able to have an mri?
In theory, it it possible to meet the diagnostic criteria without having an MRI (see the criteria at 8:30 in the video). In practice, and MRI is helpful to confirm the diagnosis of MS and rule out other condtions.
How do i get diagnosis? A neurologist?
Typically a neurologist would treat multiple sclerosis.
Remyelination
Why can it take years for lesions to develop / show up when one is having neurological symptoms and abnormal exam findings?
Typically, the opposite is true...that lesions are present long before the onset of symptoms. It is very rare for someone with MS to have a normal MRI brain at the time of symptom onset (though I have actually seen this before).
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This is me. Getting worse. MS Hope diet my best option. Matt Embray and will power is best option.
What is Attack....
What is Objective Clinical Evidence...
What DIS...
What is DIT...
Please clarify these...My Sire😳😳😳
An attack is a clinical event consistent with injury to the nervous system seen in people with multiple sclerosis (i.e. pain and vision loss in one eye). Objective clinical evidence would be something that the provider finds (exam findings, abnormal visual evoked potentials, etc.) DIS is evidence that there is injury in different areas of the nervous system. DIT is evidence of an ongoing disease that is injuring the nervous system at different times.
My neighbor supposed to have MS since 15 years. He „can’t“ work, but he works all these year in his yard like a bull !
Thanks
Can person suffer from essential tremor become Neurologist?!
Sure. one of my friends who is a neurologist has essential tremor.
@@DrBrandonBeaber Thank u from my heart for ur replay
Just curious, does MS cause brain waves to be different on an EEG?
Also, what is technically going on in an MS brain that causes structures like the thalamus to appear differently?
There is an association between MS and increased risk of epilepsy, but there is (generally speaking) no specific EEG finding which is associated with MS.
I’ve been fascinated by the MS brain ever since I was diagnosed.
Since going through nursing school 20 years ago(!) I’ve always been more interested in pathophysiology than physiology. Not in just how the body works, but in all the hidden patches and compensations a body goes through while trying to hold itself together. Now I have a condition that’s full of them :)
Thank you for your reply and all your videos😊
The functionality of disease labeling..... ethical application of different protocols to minimize human suffering. Are you sure your an American doctor?
??
@@DrBrandonBeaber mocking the lack of mechanical understanding intrinsic and essential to 99.9999% of all mental health diagnosis..... ie you don't seem to suffer from dominant monkey syndrome. Congratulations on your evolution beyond your peers .
Thank you, did not planto watch, glael I did.
Hi
It's not moraly appropriate to make a happy face while talking about a problem or desease, dear doc!
Nothing wrong with his speech on the subject
Are you serious!!! This guy is amazing and makes me feel comfortable. Easy to watch and listen to!!! His demeanor is awesome!!!
Dr people want to know what the cause of ms is. There are diseases and environmental illnesses being ignored that cause these neurological problems. Persistent pathogens.
get to the friggin point
The heat is really bad for me. It really sucks. I am in Texas 😅🥲🔥💥🔥