DIAGNOSTIC CRITERIA OF MULTIPLE SCLEROSIS: CURRENT APPROACHES AND CLINICAL SIGNIFICANCE

INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE Volume 02, Issue 12, 2025 127 INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE universalconference.us DIAGNOSTIC CRITERIA OF MULTIPLE SCLEROSIS: CURRENT APPROACHES AND CLINICAL SIGNIFICANCE Yaqubov Ilyosbek Yaxyobek o`g`li Andijan State Medical institute. Master`s student Abstract Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. Due to the heterogeneity of clinical manifestations and the absence of a single pathognomonic test, early and accurate diagnosis remains a major clinical challenge. The introduction of the McDonald diagnostic criteria has significantly improved diagnostic accuracy by integrating clinical, radiological, and laboratory findings. This thesis reviews the current diagnostic criteria for multiple sclerosis, emphasizing the role of magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and evidence of dissemination in space and time. Keywords: Multiple sclerosis, diagnostic criteria, McDonald criteria, MRI, cerebrospinal fluid, oligoclonal bands. INTRODUCTION Multiple sclerosis is one of the most common non-traumatic causes of neurological disability in young adults, typically affecting individuals between 20 and 40 years of age. The disease course is highly variable, ranging from benign forms to rapidly progressive disability. Early diagnosis is crucial, as disease-modifying therapies can reduce relapse rates, delay disability progression, and improve long-term outcomes. Therefore, standardized and evidence-based diagnostic criteria are essential for clinical practice and research. Pathophysiological Basis of Diagnosis The diagnostic framework of MS is based on demonstrating inflammatory demyelinating lesions within the central nervous system that are disseminated in both space and time, while excluding alternative diagnoses. Table 1. Pathophysiological Features Relevant to MS Diagnosis Feature Description Diagnostic relevance Demyelination Immune-mediated damage to myelin Causes characteristic MRI lesions Axonal injury Neurodegeneration accompanying demyelination Explains irreversible disability Inflammation T-cell and B-cell mediated immune response Reflected by CSF abnormalities Gliosis Chronic scarring of CNS tissue Seen in long-standing lesions Clinical Diagnostic Criteria Clinically, MS is suspected in patients presenting with neurological deficits consistent with CNS demyelination, lasting at least 24 hours, in the absence of fever or infection. Common initial presentations include optic neuritis, sensory disturbances, motor weakness, and brainstem syndromes. Table 2. Common Clinical Manifestations Suggestive of MS INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE Volume 02, Issue 12, 2025 128 INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE universalconference.us System involved Typical symptoms Optic nerve Visual loss, pain on eye movement Spinal cord Limb weakness, sensory level, bladder dysfunction Brainstem Diplopia, vertigo, dysarthria Cerebellum Ataxia, tremor, coordination impairment McDonald Diagnostic Criteria The McDonald criteria (latest revisions: 2017, with emerging updates in 2023) integrate clinical attacks, objective neurological findings, MRI features, and CSF analysis. Dissemination in Space (DIS) DIS is demonstrated by MRI evidence of lesions in at least two of the following CNS regions: • Periventricular • Cortical or juxtacortical • Infratentorial • Spinal cord Table 3. MRI Criteria for Dissemination in Space CNS region Typical MRI characteristics Periventricular Ovoid lesions perpendicular to ventricles (“Dawson’s fingers”) Cortical / Juxtacortical Lesions abutting the cortex Infratentorial Brainstem or cerebellar plaques Spinal cord Short-segment, peripheral lesions Dissemination in Time (DIT) DIT reflects disease activity over time and can be demonstrated by: • Simultaneous presence of gadolinium-enhancing and non-enhancing lesions on MRI • New lesions on follow-up MRI • Presence of CSF-specific oligoclonal IgG bands Table 4. Methods to Demonstrate Dissemination in Time Method Diagnostic significance Contrast-enhanced MRI Differentiates active vs. chronic lesions Follow-up MRI Shows new lesion formation CSF oligoclonal bands Indicates chronic immune activation Cerebrospinal Fluid Analysis CSF examination plays a supportive but critical role in MS diagnosis. The most characteristic finding is the presence of CSF-restricted oligoclonal IgG bands, detected by isoelectric focusing. Table 5. CSF Findings in Multiple Sclerosis Parameter Typical finding Oligoclonal bands Positive in ~85–95% of MS patients INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE Volume 02, Issue 12, 2025 129 INTERNATIONAL CONFERENCE ON INTERDISCIPLINARY SCIENCE universalconference.us Parameter Typical finding IgG index Elevated Cell count Normal or mild lymphocytosis Protein Normal or mildly increased Differential Diagnosis Several conditions may mimic MS and must be carefully excluded. Table 6. Differential Diagnosis of Multiple Sclerosis Condition Key distinguishing features Neuromyelitis optica (NMO) AQP4-IgG positivity, longitudinal spinal lesions Acute disseminated encephalomyelitis (ADEM) Monophasic, post-infectious CNS vasculitis Systemic inflammation, angiographic changes Vitamin B12 deficiency Metabolic abnormalities, symmetrical lesions Conclusion The diagnosis of multiple sclerosis requires a comprehensive and systematic approach that integrates clinical evaluation with advanced neuroimaging and laboratory investigations. The McDonald criteria provide a reliable framework for early and accurate diagnosis by emphasizing dissemination in space and time. MRI and CSF analysis remain cornerstone tools in modern MS diagnostics, allowing clinicians to initiate disease-modifying therapy at an early stage and improve long-term patient outcomes. References 1. Thompson AJ, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2. McDonald WI, et al. Recommended diagnostic criteria for multiple sclerosis. Ann Neurol. 3. Compston A, Coles A. Multiple sclerosis. Lancet. 4. Filippi M, et al. MRI criteria for the diagnosis of multiple sclerosis. Nat Rev Neurol.