Newly Proposed Diagnostic Criteria May Lead to Earlier Diagnosis of MS

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With the inclusion of s-gadolinum enhancing lesions for dissemination in time and/or CSF oligoclonal bands as a substitute for dissemination in time demonstrated a 10 month early diagnosis.
With the inclusion of s-gadolinum enhancing lesions for dissemination in time and/or CSF oligoclonal bands as a substitute for dissemination in time demonstrated a 10 month early diagnosis.

The implementation of newly proposed or revised 2017 McDonald diagnostic criteria may lead to an earlier diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS), according to a recent study published in Journal of Neurology.

This retrospective study was conducted in light of new McDonald diagnostic criteria formulated from recent scientific literature, reviews, and recommendations made by the International Panel on Diagnosis of MS and a 2016 consensus by the MAGNIMS network. These updated diagnostic criteria have a basis the following clinical findings: symptomatic and asymptomatic magnetic resonance imaging (MRI) lesions used to determine dissemination in time (DIT) and dissemination in space (DIS); the contemporaneous presence of gadolinium-enhancing (Gd+) and non-enhancing (Gd−) lesions on MRI scans; the presence of symptomatic lesions; and, for patients with a single clinical attack and evidence of DIS, the presence of cerebrospinal fluid (CSF)-specific oligoclonal bands (OCB) that would otherwise substitute for observed DIT.

In the study, the effect of applying newly proposed MRI criteria within the 2010 McDonald diagnostic criteria for DIT was tested in a cohort of study participants (N=137; average age 31.4 ± 10.5 years; 2.9 female/male ratio) with CIS who satisfied the 2010 revised McDonald MRI criteria of DIS. Patients were included in the study if their Gd+ lesions were symptomatic (s-Gd+lesions). A Cox survival analysis was conducted to assess the impact of the application of the 2017 McDonald diagnostic criteria in specific patients with CIS. A P value lower than 0.05 was considered statistically significant.

The inclusion of s-Gd+lesions in the lesion count for DIT and CSF OCB vs DIT only led to early MS diagnosis in 113 out of 137 patients (82.5%) upon the first demyelinating event. The previous diagnostic criteria would have otherwise failed to identify MS in these individuals.  Investigators observed that the inclusion of s-Gd+lesions and/or CSF OCB for DIT would have led to an early mean diagnosis of 10.7 ± 19.4 months.

The researchers noted a specific study limitation: the results can only be applied to patients with MRI evidence of DIS. They suggested conducting further studies to corroborate their findings.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to original reference for a full list of authors' disclosures.

Reference

Gaetani L, Properini L, Mancini A, et al. 2017 revisions of McDonald criteria shorten the time to diagnosis of multiple sclerosis in clinically isolated syndromes [published online September 8, 2018]. J Neurol. doi:10.1007/s00415-018-9048-8

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