Donald A. Barone, DO
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Associate Professor and Chief, Division of Neurology,
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…on the evolution of diagnostic criteria in MS
“Early in my career, with no proven therapy, there was no rush to diagnose MS. Without the right tools, a diagnosis couldn’t be reached quickly anyway. Evoked potential studies were eventually developed to assess optic nerve and other central nervous system (CNS) conduction abnormalities. More sophisticated spinal fluid analysis, including tests for immunoglobulin G index and oligoclonal bands, helped to establish the MS diagnosis. Magnetic resonance imaging (MRI) emerged in 1984, but this required several years to become established as the most valuable aid in the diagnosis of MS.
“Criteria evolved over the years, although we still lack an absolutely definitive diagnostic test for MS. The Schumacher Criteria, dating from the 1960’s, required the clinical demonstration of two or more CNS abnormalities separated in time and space. The Poser Criteria in 1983 added evoked potentials and spinal fluid analysis to the diagnostic mix. Finally in 2000, the McDonald Criteria emphasized the importance of MRI evidence in establishing the MS diagnosis, with revisions in 2005 and 2010 – giving the MRI even more importance.
“How things have changed! There is still much more to be done, but it is gratifying to look back on the progress I have witnessed since starting my residency with Drs. Poser and Schumacher in 1975.”
Dr. Donald A. Barone attended Rutgers College and the Philadelphia College of Osteopathic Medicine. While a resident at the University of Vermont Medical Center, he worked with Doctors Schumacher and Poser, two prominent MS experts. He participated in clinical trials in the 1980s and early 1990s, and completed a fellowship in neuromuscular disorders at Columbia Presbyterian Medical Center in New York. Dr. Barone has directed and taught the neurology courses at the University of Medicine and Dentistry of New Jersey since 1978. In addition to serving on an NMSS advisory committee and lecturing, he has a large MS clinical practice and is a principal investigator in several MS trials.