Article of interest (8): a clinico-pathological study of MS

A

Engell T. A clinico-pathoanatomical study of multiple sclerosis diagnosis. Acta Neurol Scand. 1988 Jul;78(1):39-44.


Background: The diagnosis of MS is clinical and only verifiable at post mortem. 


Results: Examination of 518 consecutive patients with clinically definite MS at post-mortem revealed a correct diagnosis in 485 cases (94%). Clinical diagnosis had been established by a neurologist in all cases. Erroneous diagnosis included a variety of other neurological disorders. Also investigated was a randomly selected series of 33 patients with a clinical diagnosis of probable MS: post mortem confirmation of MS was obtained in only 66% of these cases.

Conclusion: Clinical diagnosis of definite MS was correct in 94% cases. Laboratory tests and examinations have not radically improved diagnosis. The one caveat to this study is that pathological examination of the subject may occasionally fail to demonstrate MS plaques if the optic nerves are not investigated.

“This is study is not alone in finding a error rate of ~5%. Please try and understand that this problem is not unique to MS and occurs in all fields of medicine.”

“This study was done in an era that mainly predated MRI so the error rate may have improved slightly since MRI has been introduced. However, counteracting this improvement is the change in the MS diagnostic criteria that now allows an earlier diagnosis, even after one clinical attack. Earlier diagnosis will increase the error rate as the disease has not fully declared itself.”

“For those of you who are surprised by this study’s findings, you may find the following famous quote by the German Physician Heinrich Lahmann helpful: ‘Medicine is not a science but an art, and the true physician is nothing more than a skillful artist’. In my opinion, medicine is not black-and-white, it is 
simply a palette of different shades of gray. Please don’t let anyone try and fool you that it is different.”

 

                                            Picutre Added by MD

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

2 comments

  • By the disease "fully declaring itself", do you mean that someone needs to have a second relapse to make their dx one of "Definite MS" rather than "Probable MS"? What about the recommendations that MSers should be on a DMT as soon as they're diagnosed in order to receive the maximum benefits of the treatment. A decade could pass between someone's first attack and their second. Isn't that too late, at least for the injectables?

  • Thank so much for pointing it out that Doctors do the best they can it's why doctors have a license to practice medicine. As a patient it's my job to give you as much information about what's happening and what I'm feeling is going on with me, of course too much information can make your job much harder too.
    Doctor's are the artist we are the canvas, by working together a picture of honesty where information is passed back and forth to help both of us learn.

By Prof G

Translate

Categories

Recent Posts

Recent Comments

Archives