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Barkhoff criteria?

Hi guys, just a quickie, don’t know if anyone can help? Just had a copy of a letter from my neuro to my doctor telling her that he is arranging for me to have an LP. I have a couple of white matter changes on my MRI but my EPs are fine so I don’t fulfill ‘Barkhoffs Criteria’. I can’t find anything about it on this site and nothing useful on my squintynet searches. Anyone know what it is? Many thanks, Margaret :slight_smile: xx

It’s Barkhof, not Barkhoff - so that might explain the problem finding it. Basically, Barkhof’s criteria are the ones that the 2005 McDonald criteria used for showing dissemination in space. That was that you needed 3 of the following 4: - 1 enhancing lesion OR 9 lesions - 1 infratentorial lesion (i.e. cerebellum, brain stem or spinal cord) - 1 juctacortical lesion (i.e. a lesion next to the gray matter) - 3 periventricular lesions (i.e. lesions next to the ventricles). Apart from the fact that your neuro doesn’t know how to spell it(!), there is a problem with this conclusion by your neuro. The 2005 guidelines were replaced earlier this year. The new guidelines (the Swanton criteria) are only that you have at least one lesion in two typically MS areas (periventricular, juxtacortical, infratentorial and spinal cord). Very very very much less than the old Barkhof criteria! I’m not sure how best to handle this; tricky. Is this neuro an MS specialist? Has he seen the Polman et al paper in which the latest guidelines were published? Would someone else be more up to date? Perhaps you should print the paper and decide with your GP how to use it? Just google: Polman 2011 Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. It’s free to access and download. Hth. Karen x

rizzo27 wrote:

It’s Barkhof, not Barkhoff - so that might explain the problem finding it. Basically, Barkhof’s criteria are the ones that the 2005 McDonald criteria used for showing dissemination in space. That was that you needed 3 of the following 4: - 1 enhancing lesion OR 9 lesions - 1 infratentorial lesion (i.e. cerebellum, brain stem or spinal cord) - 1 juctacortical lesion (i.e. a lesion next to the gray matter) - 3 periventricular lesions (i.e. lesions next to the ventricles). Apart from the fact that your neuro doesn’t know how to spell it(!), there is a problem with this conclusion by your neuro. The 2005 guidelines were replaced earlier this year. The new guidelines (the Swanton criteria) are only that you have at least one lesion in two typically MS areas (periventricular, juxtacortical, infratentorial and spinal cord). Very very very much less than the old Barkhof criteria! I’m not sure how best to handle this; tricky. Is this neuro an MS specialist? Has he seen the Polman et al paper in which the latest guidelines were published? Would someone else be more up to date? Perhaps you should print the paper and decide with your GP how to use it? Just google: Polman 2011 Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. It’s free to access and download. Hth. Karen x

Hi Karen. Thanks so much for your reply. Spelling my mistake I’m afraid (although the letter spelled it Barkoffs, lol). :slight_smile: I think the neuro has a special interest in ‘Headache and chronic pain, treatment of neuropathic pain pain management, nerve damage’ but I did notice (when trawling last week) that he was taking part in a local seminar to nurses and speaking about diagnosis of MS and latest drug management. I think that I shall follow your advice and have a chat with my GP about my concerns. I’m sure any comment/question might be better received if it comes from another health professional! Take care, Margaret :slight_smile: xx