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539156 tn?1281818356

Trying to understand the McDonald Criteria...

OK, I think I understand that if 2 things in the neuro exam and at least one brain lesion (I have 6) there is a dx of MS.  Here are some notes from my EMG report:  7 year history of gradually progressive feet>hand paresthesias associated with left hand incoordination and gait unsteadiness. Patient also has persistent fatigue. A focused neurologic exam demonstrates normal strength (no it doesn't!) hyporeflexia in the right ankle, decreased sensation in both feet and all fingertips.
Then there's a bunch of numbers, graphs, etc.and a conclusion: Abnormal study. These electrodiagnostic findings are consistent with a mild - to - moderate sensory>motor, predominantly axonal polyneuropathy. Clinical correlation is advised.  
Please! Somebody tell me what this stuff means.  
Thanks in advance....
Mary Kay
11 Responses
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572651 tn?1530999357
Mary Kay,
I am not a doctor or a clinician - but I think it is saying your problem is neurological and not muscular/skeletal. If I'm wrong, someone will correct me I'm sure.

What I wanted to write though is I am glad you are done waiting for these test results.  Are there others you are waiting on too or is this it?  When is your next neuro appt to discuss these ?

My best,
Lulu
Helpful - 0
539156 tn?1281818356
Yes, there are others.  I had 6 vials of blood drawn after I got the results of my brain MRI. They were for Lupus (normal), RA (normal), Narcolepsy panel (not back yet), SED rate (don't have that either), and 2 more that I can't remember the names of. The word nuclear was in them. My neuro said MS was on the table, but she wanted all this blood work done, maybe a sleep study, and a lumbar puncture before coming to that conclusion.  I wish I didn't have to have the LP if a dx is right there now.  Of course I wish there was something "fixable" wrong with me, but I have my doubts at this point.  If I do have MS, I just want to get going on whatever I need to do to slow it down. Seems like things have really gotten worse this past year. It's so hard to do my best at work with this fatigue and weak legs.  Thanks for being there,  Mary Kay
Helpful - 0
333672 tn?1273792789
I think the axonal polyneuropathy is a kind of peripheral neuropathy. You probably had a nerve conduction study with the EMG (sometimes they seem to call the whole thing EMG), which did show a neurological problem, but in the peripheral nervous system and not the central nervous system (MS is only in the CNS).

I was dx'd with mild sensory polyneuropathy until I saw a peripheral neuropathy specialist who did more tests and said MS not PN.

I don't know what this means for you. You'll have to talk to your neuro. If you have peripheral neuropathy, try to get them to figure out what is causing it. Idiopathic is pretty doomed as a dx.

Depending on your other symptoms, I think this would tend to be evidence against MS.

sho
Helpful - 0
539156 tn?1281818356
Thanks for your input.  I think I read somewhere that the EMG results that show little or no nerve damage to the feet and hands is actually a "good" pointer to the damage being somewhere else like the spinal cord or brain.  ???  
Helpful - 0
333672 tn?1273792789
I've never heard that, but hopefully your neuro will get it all straightened out.

Here's a link to an article called "An Algorithm for the Evaluation of Peripheral Neuropathy" which is a little old (1998), but seems pretty thorough and might be helpful:

http://www.aafp.org/afp/980215ap/poncelet.html

I hope you get some solid answers quickly.

sho
Helpful - 0
147426 tn?1317265632
Hi, there.  Let me help you with the McDonald Criteria.

First you should have 2 or more distinct attacks (relapses, flare ups, exacerbations)

Then you should also have 2 or more abnormalities on your neuro exam that each point to separate areas of the Central Nervous System being damaged.  These abnormalities have to be of the type seen in MS.  Areas of reduced sensation weakness sould definitely count.  But, the doc didn't see the weakness so it can't "officially" be used.

Now, in the best of worlds, if the mimics have been ruled out then you could be diagnosed with MS.  But, in your case, HYPOreflexia is uncommon in MS.  It is much more common to have hyPER reflexes, so that might not count.  Some neuros won't count things that they can't prove or actually see (like numbness).  So you are iffy on the clinical lesions side.

Most neuros will require definite lesions on MRI if the attacks and exam thing fulfill the Criteria.  In the field of people who are studying how worthwhile the McDonald Criteria are, most are suggesting that 2 lesions in 2 separate areas commonly hit by MS should be used also.

If you are missing an attack or have only one definite abnormality on exam, then you have to go to those unwieldly tables of using MRI data (sometimes with LP and/or VEP results) to serve in place of the missing attack or the missing lesion on exam.

I am bad at interpreting EMG/NCS reports.  It sounds like yours was positive and that would point away from MS and more toward a peripheral polyneuropathy.  This disorder would account for the HYPOactive reflex, I think.  I would also cause weakness and numbness.

The LP will be important.  I don't think you have a diagnosis yet.  Did all this make sense?

Quix
Helpful - 0
195469 tn?1388322888
Even though I have had MS for a long time, I don't have the knowledge to answer your question responsibly.  I can say that while you have the lesions and symptoms for sure, that the McDonald Criteria also talks about two (at least) distinct relapses and remissions.  I hope I am right about that...

Axonal polyneuropathy does lead me towards neurological in nature of course.  

We have alot of very savvy members who may be able to answer you much better than I ever could.  With Quix dealing with her daddy right now, she may check in and see your question and be able to answer it.

A dissemination in time is the only thing left to prove, in my opinion, to diagnose MS.  I forget also, if you have had a Lumbar Puncture.

Sorry I couldn't help.  I wanted to, but am totally inept.

Big Hugs,
Heather
Helpful - 0
539156 tn?1281818356
Thanks so much...You really have answered some of my questions.  So if I end up with a "dx" of peripheral polyneuropathy and no MS, what in the world will I do about the FATIGUE that is killing me, or my increasing loss of fine motor abilities?  I am supposed to have a LP, and as I said, I do plan to go to a MS Center, so hopefully they can help me.
Thanks again,
Mary Kay
Helpful - 0
539156 tn?1281818356
I forgot to ask...If it isn't MS, why would I have 6 lesions in my brain?  
Helpful - 0
147426 tn?1317265632
Well, now, I didn't say that I don't think you have MS.  Your fatigue, your symptoms, your lesions all suggest it strongly.  Your exam - not so definitely.

I just said you don't have enough from what you have told us to slam dunk a diagnosis.  I do think you'll need an LP.  I agree; MS is definitely on the table.

All of the MS mimics cause brain lesions.  And, as we all know, some lesions can be from other causes.

I was just trying to answer your query as to whether, based on the info we have heard, analysis of the McDonald Criteria can give you a definite diagnosis, and I don't think so.  Now, a good MS specialist can put the whole thing together and make a judgment that may not fall within the M.C.  Mine did.  I didn't have a good history of two attacks.  I only had one lesion, the mimics were ruled out. my exam was perfect for MS, my LP showed only 1 band and the IgG Index was elevated.  He called it a "greater than 90% certainty in his mind.  A month later when the 3T showed that I had numerous spinal lesions it was a certainty.

Does that make sense?

Quix
Helpful - 0
539156 tn?1281818356
Yes, it does.  It is just like me to NOT have a simple case.  LOL  I don't know if I mentioned this, but I don't think my current neuro did a very thorough exam.  That will come when I go to the specialist.  
Thanks again for everything,
Mary Kay
Helpful - 0
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