Neurology® Podcast Investigating Whether Dissemination in Time Is Essential to Diagnose Relapsing MS
Mar 6, 2025
Dr. Wallace J. Brownlee, a renowned neurologist specializing in multiple sclerosis from Queen Square MS Centre, dives into the evolving landscape of MS diagnosis. He discusses the diminishing focus on dissemination in time (DIT) when high dissemination in space (DIS) criteria are met. The conversation also covers advanced diagnostic techniques like MRI and cerebrospinal fluid analysis. Brownlee outlines the significance of detecting lesions and emphasizes the role of optic neuritis in refining current guidelines for diagnosing relapsing remitting MS.
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DIT's Origins
- Dissemination in time (DIT) for MS diagnosis is a holdover from the pre-MRI era, useful when only clinical skills were available.
- Modern MRI and updated McDonald criteria question the ongoing need for DIT.
DIS as Primary Diagnostic Criteria
- High fulfillment of dissemination in space (DIS) criteria, with lesions in 4-5 MS-typical regions, may suffice for MS diagnosis.
- Additional evidence like lumbar puncture might not be necessary in such cases.
MS Diagnosis Algorithm
- Start by excluding other conditions and perform an MRI of the brain and spinal cord.
- If four affected regions show lesions, diagnose MS; if fewer, assess the optic nerve.