Journal Club - 2006-04-11

Dx of Multiple sclerosis

Using optic neuritis as an example

• 7% of pts with optic neuritis have current MSs
  • Beck RW et al Abstract Brain magnetic resonance imaging in acute optic neuritis. Experience of the Optic Neuritis Study Group. Arch Neurol. 1993 Aug;50(8):841-6. PMID: 8352671
    • Shows 418 total pts in the Optic Neuritis Study Group
  • Beck RW et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.
    Arch Ophthalmol. 2003 Jul;121(7):944-9.
    PMID: 12860795
    • Shows 388 initially without MS in the Optic Neuritis Study Group
• 40% will eventually have MS
  • Beck RW et al. High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis: experience of the optic neuritis treatment trial.
    Arch Ophthalmol. 2003 Jul;121(7):944-9.
    PMID: 12860795

http://medinformatics.uthscsa.edu/ars/

What do PIER and UpToDate say?

• Has anything more recently been published?
  • BMJ - 2006

What is role of oligoclonal bands (OCBs) in CSF?

1. Are OCBs better than CSF protein?
2. When are OCBs tested versus MRI?

What test for OCBs does our hospital use?

• Gold standard is diagnosis of clinically definite MS. Cellulose or agarose gel technique not as good asi soelectric focusing technique.