Hi, Cherie. I think you have misunderstood my intent in writing this, but have likely brought up something that I need to incorporate early in the piece. I am surprised that you had such misgivings about the piece, because I know that it has a place in the stuff that people along the way need to access. At some point, and I knew you have such people here, those who have been dismissed by lazy or ignorant neuros need and want to see the criteria that "damned" them.

This piece was already epically long and I was trying to keep it more directed.

Q

BUT,
Let's all talk about the way this piece is prefaced so that it is clearly for the person [I]very[I] far along in the diagnostic process - a true Limbo Lander.

Given your concerns, it seems I need a brief, but very definite, statement in the beginning that states that the person who is just starting on the road of suspicion of MS needs an extremely thorough history and neuro exam, an initial set of MRI's, and exclusion by testing of the mimics of MS in general, and an exclusion of specific mimics by special testing that might include EMG/NCV, EEG, lumbar spine films or MRI, evaluation by a rheumatologist, etc.

I agree, The McDonald Criteria should not be used early by someone to self-diagnose. It is too specific and technical and is too strict in its definitions to be used by someone who isn't already diagnostic "waste."

Or do any of you believe that a layman's description of the McDonald Criteria should not be available at all to people?
Quix

The following is an edit:

Wow! I just read your whole comment and I have to disagree in several places.

[QUOTE]- are just starting the dx procedure[/QUOTE]

I do not think that people early in the dx process need to be worrying about the MC. That is for their neuro's to tease out, because that's their job.

[QUOTE]- want to know alternate dx possibilities [/QUOTE]

The McD C has nothing to do with alternate Diagnoses, thus, this would not be a suitable place to look.

I disagree with several things here. Many neuros do lean heavily on the clinical part, and those are the one's we need to be seeing. On forums such as ours we see a skewed view of what "usually" happens in the Dx process. The people who are diagnosed properly or easily often do not seek out a forum, having had no difficulty with the diagnosis. If they do, their interest in the diagnostic process is less passionate and they may read, but not post. Some will offer their experience, but it is the exception.

I believe the rigid-thinking Neurologist is NOT predisposed to become less riged and more open to the possibilities as he is proven wrong in his initial thinking. That is not how this type of physician reacts in my 23 years of interacting with them. They are generally less and less likely to admit their initial path was in error.

I know people four, including myself, who were diagnosed with negative or atypical MRI and LP findings. I had only one misplaced, small, frontal lobe lesion when I got my diagnosis.

Yes, the statement that doctors tend to place disproportionate weight on the MRI and LP is necessary, but the topic of the McD C is to explain them not to explore all their misuses.

Oh, Cherie, I can't diagree with you more! I realize this goes back to a fundamental difference in the opinion we two have on this subject. But, in my experience, both on a forum and in medical practice, KNOWING that something is wrong, but having the door slammed on them dashing their hope is devestating to every person I have encountered except you, though I will give you that there are likely many, many more. People in this situation are pressed into despair and their hope is taken away. The increasing symptoms constantly remind them of their hopeless state, either forcing them to consider that they actually are crazy or that they will die without anyone acknowledging their pain and disability.

Where I come from, we have had more than half a dozen, realize that their there are different doctors and different ways to approach the diagnosis - who then have proceded to get a diagnosis! You are the only person to whom I have ever spoken who would prefer to accept KNOWING that you have something wrong and NOT knowing what it is. I believe that most people prefer a named enemy than an unnamed one who is stealing their life and abilities.

The good neurologist will help counsel those whose bodies do not give up the evidence and assure them they will continue to look and monitor over time. I believe it is worth the effort to seek out these docotrs, but they are not few and far between. My friends have eventually found them. It is easier to live with the frustration of no diagnosis when you have the validation of a doctor who believes you and will continue to search. I believe this with all my heart.

I've run out of time here to discuss all the other things I read in your post but, please remember, that wanting to have all these other topics discussed is actually wishing there was a book, written in plain English by someone who understands the technical stuff, so that everything is complete. That is a worthwhile desire and possibly a goal.

What I am doing is getting around with limited energy to writing on "topics" that are necessarily limited in scope. The discussion of MS Mimics and other diseases with have O-Bands is not appropriate in a topic called The McDonald Criteria. Nor is a discussion on the UNnecessity of an LP. Though it is probably worth pointing out that the McD C rarely require an LP. The diagnosis can be made without one and OFTEN IS.

Perhaps there should be a companion article recommended which does discuss some of these things. All I attempted to do was explain the McD C - not to justify the way they are used. Even so, if you read my article you will see how much emphasis I put on the History and Neuro Exam and by, the way the McD C are formulated how much the authors of it placed also on the clinical signs.

I will agree that the article could use some qualification as to what it is and who might benefit from it. But, at some point people will look up the McDonald Criteria to see what it is about - and it is hard reading.