I completely agree with you. We can't change the way some neurologists make their diagnostic decisions. And the result of a lot of those decisions leave us in a wasteland. But, if we already know the pitfalls, and the way they should be analyzing the information, we are better able to fend for ourselves. We can dump the defective neuros earlier and guid the wishy-washy ones with pointed questions.

As to whether these Criteria are hard and fast, you will get varying answers to this. It is stornger than a Guideline, but weaker than a Federal Law. Generally Criteria are more to be followed than not. Neuros with less confidence and skill will be "safe" if they follow them rigidly. They will be able to defend their decisions if challenged. Truly smart, skilled and confident doctors know when they can see a wider picture and diagnose outside the Criteria.

The "problems" of diagnosing outside the Criteria are 1) a weaker defense if challenged, 2) some patients won't qualify for certain studies, 3) certain meds may not be approved, and 4) potential problems with insurance.

Someone said recently that Neurologists are often linear, mechanical thinkers. A person may qualify for diagnosis until the MRI is atypical. Then, that supercedes the earlier information. We should attempt and look for the non-linear thinker who can think and evaluate laterally - seeing a global picture that shows the diagnosis, despite varying from the Criteria.

The upshot is that we can't know when we have been snookered without good information. I do believe there is no such thing as too much information.

Quix