What are the key diagnostic criteria for identifying multiple sclerosis in a primary care setting?

Key diagnostic criteria for identifying multiple sclerosis (MS) in primary care include:

• Recognising typical neurological symptoms such as loss or reduction of vision in one eye with painful eye movements, double vision, ascending sensory disturbance and/or weakness, Lhermitte's sign (altered sensation or pain down the back when bending the neck forwards), and progressive difficulties with balance and gait.
• Noting that patients are often under 50 years old, may have a history of previous neurological symptoms, and symptoms usually evolve over more than 24 hours, persist for days or weeks, and then improve.
• Excluding symptoms primarily of fatigue, depression, dizziness, or vague sensory phenomena unless there is a history or evidence of focal neurological signs.
• Performing an initial assessment including history, physical examination, and exclusion of alternative diagnoses before referral.
• Referring suspected cases to a consultant neurologist for diagnosis using the 2017 revised McDonald criteria, which require evidence of lesions in the central nervous system that have developed at different times and in different anatomical locations, supported by MRI and laboratory findings.
• Considering cerebrospinal fluid-specific oligoclonal bands if clinical or radiological evidence of dissemination in time is lacking.
• Not diagnosing MS based on MRI findings alone in primary care.

These steps ensure appropriate identification and timely referral for specialist diagnosis and management of MS.

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