Résumé
ABSTRACT Objective: To evaluate the prevalence of prior inflammatory events in patients consulting for a first inflammatory neurological event, and improve early diagnosis of multiple sclerosis. Methods: During the initial visit, the neurologist gave patients a self-administered questionnaire containing 72 questions regarding previous symptoms lasting more than 24 hours. During the follow-up visit the neurologist validated the symptoms and collected information about the current attack. Results: The cohort included 178 patients (74% women, mean age (±SD) 33.7 (±10.1) years). The main reason for the initial visit was visual disturbance and sensory troubles in limbs. Mean (±SD) global EDSS score was 1.4 (±1.1), 46% of brains MRIs were positive according to Barkhof-Tintoré criteria, 41% had abnormal WBC count in CSF and 71% had IgG oligoclonal bands. Prior symptoms suggestive of demyelination were reported by 79 patients (44%), validated by the neurologist for 70% (55 patients) and identified only by the neurologist in four patients. Sequelae were observed in 14 patients with validated prior symptoms (26%). The self-administered questionnaire showed an overall sensitivity of 93% and specificity of 80% for identifying patients with prior symptoms suggestive of demyelination. Conclusion: A patient-administered questionnaire subsequently validated by the neurologist demonstrated that 33% of patients consulting for a first demyelinating event had prior symptoms suggestive of CNS demyelination that had gone unnoticed, and almost 70% had either sequelae of prior demyelination or McDonald criteria for dissemination in space. Such a questionnaire could be a useful tool for earlier diagnosis of multiple sclerosis.