Researchers from the Universitat Autònoma de Barcelona in Spain found that incorporating features of the optic nerve into multiple sclerosis (MS) diagnostic criteria improved diagnostic performance by increasing sensitivity without lowering specificity, according to study results published in Neurology.

Data for this study came from a prospective study of 1238 patients diagnosed with clinically isolated syndrome after a single magnetic resonance imaging (MRI) scan performed between 1995 and 2017. Study investigators retrospectively assessed data of visual evoked potentials through patient medical records. They split patients into risk assessment (n=388) and diagnostic criteria performance (n=151) cohorts to validate whether MS diagnostic criteria improved with the addition of optic nerve information.

At clinically isolated syndrome diagnosis, patients were a mean age of 31.6 (standard deviation [SD], 8.2 years). 68% of patients were women; 63.6% had nonoptic neuritis; 58.8% were positive for oligoclonal bands; 71.2% had an abnormal MRI; 37.8% had abnormal visual evoked potentials; and the median extended disability status scale was 1 (range, 0-5.5).


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Among cohort 1, persons with higher levels of diagnostic criteria were at increased risk for a second attack from 1 criterion (hazard ratio [HR] 5.6; 95% CI, 1.9-16.5) to 5 criteria (HR 22.7; 95% CI, 7.9-65.7).

The 2017 dissemination in space (DIS) criteria identified a similar risk for second attack (HR, 4.3; 95% CI, 2.8-6.5) as the modified DIS (modDIS) (HR, 4.8; 95% CI, 3.0-7.5). Stratified by optic nerve involvement, the risk for a second attack was projected to be elevated among patients with optic neuritis using the modDIS (HR, 4.3; 95% CI, 1.9-9.6) compared with 2017 DIS (HR, 3.8; 95% CI, 1.8-8.0).

Among cohort 2, identifying the risk for second attack at 10 years according to the 2017 DIS was less precise (sensitivity, 79.2%; specificity, 52.4%; accuracy, 75.5%; positive predictive value [PPV], 91.1%; negative predictive value [NPV], 28.9%) compared with the modDIS (sensitivity, 82.3%; specificity, 52.4%; accuracy, 78.1%; PPV, 91.4%; NPV, 32.3%).

Similarly, among only the patients with optic neuritis, the 2017 DIS predicted a second attack at 10 years with a poorer overall performance (sensitivity, 69.7%; specificity, 57.1%; accuracy, 67.5%; PPV, 88.5%; NPV, 28.6%) compared with the modDIS criteria (sensitivity, 75.8%; specificity, 57.1%; accuracy, 72.5%; PPV, 89.3%; NPV, 33.3%).

This study may have included some selection bias, as researchers included only patients with complete medical records in the 2 cohorts analyzed here.

According to their findings, the study researchers concluded “that the addition of the optic nerve to the current DIS criteria slightly increases the accuracy and sensitivity without lowering the specificity,” providing “additional evidence that argues in favor of including the optic nerve as a new region in the diagnostic criteria.” 

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Vidal-Jordana A, Rovira A, Arrambide G, et al. Optic nerve region in multiple sclerosis diagnosis: the utility of visual evoked potentials. Published online December 16, 2020. Neurology. doi:10.1212/WNL.0000000000011339