Failure to develop multiple sclerosis in patients with neurologic symptoms without objective evidence

Background: Many patients referred to multiple sclerosis (MS) centers with symptoms suggestive of MS are found to have normal neurologic examinations, normal or non-specific brain magnetic resonance imaging (MRI) scan findings, and normal cerebrospinal fluid (CSF). Persistent symptoms often lead to multiple consultations and repeated diagnosis investigations. We performed a study to evaluate the diagnostic utility of repeated evaluations in patients with normal initial assements and persistent neurologic symptoms. Methods: 143 patients were evaluated initially and 109 returned for a second evaluation after a mean interval of 4.4 years. Results: All 143 patients had normal initial examinations, brain MRl scans, screening blood tests, and CSF studies. Spinal cord imaging was normal in all patients tested (cervicial cord n = 126; 88.1%; thoracic cord, n = 58; 40.6%). Evoked potential studies were abnormal in a small percentage of patients: visual evoked potentials, VEP (8.1%), somatosensory evoked potentials, SSEP (4.996), and brainstem auditory evoked potentials, BAEP (2.8%). All follow-up patients (n = 109) had normal examinations and MRI scans. Repeat CSF studies (n = 35; 32.1%) and spinal cord, imaging (cervical cord n = 57; 52.3%; thoracic cord n = 32; 29.4%) were normal in all follow-up patients tested. No patients at initial presentation or at follow-up fulfilled diagnostic criteria for MS. Conclusions: Patients and clinicians may be reassured that peristent neurologic symptoms in the absence of objective clinical evidence do not lead to the development of MS. Costly serial investigations should be carefully considered, particularly in the presence of normal neurologic examination at follow-up.