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Thomas Skripuletz - One of the best experts on this subject based on the ideXlab platform.
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Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing-Remitting Multiple Sclerosis.
Frontiers in neurology, 2019Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Franz Felix Konen, Stefan Gingele, Kurt-wolfram Sühs, Mike P. Wattjes, Martin Stangel, Thomas SkripuletzAbstract:Multiple sclerosis is a chronic immune mediated demyelinating disease leading to neurological disabilities that need to be diagnosed and treated early. Guidelines on multiple sclerosis diagnosis and monitoring experienced comprehensive changes over the last decades. The first McDonald Criteria published in 2001 emphasized the importance of MR imaging but also recognized the role of cerebrospinal fluid diagnostics. The demonstration of an intrathecal immunoglobulin G synthesis is a well-established additional component and has a long tradition in the diagnosis of relapsing-remitting multiple sclerosis. However, the role of cerebrospinal fluid for diagnostic purposes was rather diminished in each revision of the McDonald Criteria. In the latest revision of the McDonald Criteria of 2017, the detection of an intrathecal immunoglobulin G synthesis as oligoclonal bands experienced a revival. Patients with the first clinical event suggesting multiple sclerosis who fulfill the Criteria for dissemination in space can be diagnosed with relapsing-remitting multiple sclerosis when oligoclonal bands in cerebrospinal fluid are detected. The diagnostic sensitivity of these novel Criteria with a focus on dissemination in time and oligoclonal bands as a substitute for dissemination in time was published in different cohorts in the last year and is of special interest in this review. Recently published data show that by applying the 2017 McDonald Criteria, multiple sclerosis can be diagnosed more frequently at the time of first clinical event as compared to the 2010 McDonald Criteria. The main effect was due to the implementation of oligoclonal bands as a substitute for dissemination in time. However, careful differential diagnosis is essential in patients with atypical clinical manifestations to avoid misdiagnoses.
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Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis.
International journal of molecular sciences, 2017Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Kurt-wolfram Sühs, Martin Stangel, Anastasia Sarikidi, Paul Bronzlik, Refik Pul, Lena Bönig, Thomas SkripuletzAbstract:While the revised McDonald Criteria of 2010 allow for the diagnosis of multiple sclerosis (MS) in an earlier stage, there is still a need to identify the risk factors for conversion to MS in patients with clinically isolated syndrome (CIS). Since the latest McDonald Criteria were established, the prognostic role of cerebrospinal fluid (CSF) and visual evoked potentials (VEP) in CIS patients is still poorly defined. We conducted a monocentric investigation including patients with CIS in the time from 2010 to 2015. Follow-ups of 120 patients revealed that 42% converted to MS. CIS patients with positive oligoclonal bands (OCB) were more than twice as likely to convert to MS as OCB negative patients (hazard ratio = 2.6). The probability to develop MS was even higher when a quantitative intrathecal IgG synthesis was detected (hazard ratio = 3.8). In patients with OCB, VEP did not add further information concerning the conversion rate to MS. In patients with optic neuritis and negative OCB, a significantly higher rate converted to MS when VEP were delayed. In conclusion, the detection of an intrathecal IgG synthesis increases the conversion probability to MS. Pathological VEP can help to predict the conversion rate to MS in patients with optic neuritis without an intrathecal IgG synthesis.
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McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity
International journal of molecular sciences, 2016Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Kurt-wolfram Sühs, Martin Stangel, Anastasia Sarikidi, Paul Bronzlik, Peter Raab, Refik Pul, Thomas SkripuletzAbstract:The 2010 McDonald Criteria were developed to allow a more rapid diagnosis of relapsing-remitting multiple sclerosis (MS) by only one MRI of the brain. Although cerebrospinal fluid (CSF) is not a mandatory part of the latest Criteria, the evidence of an intrathecal humoral immunoreaction in the form of oligoclonal bands (OCB) is crucial in the diagnostic workup. To date, the impact of the 2010 McDonald Criteria on the prevalence of OCB has not been investigated. We retrospectively evaluated data of 325 patients with a clinical relapse suggestive of demyelination that were treated in a German university hospital between 2010 and 2015. One hundred thirty-six patients (42%) were diagnosed with MS and 189 patients with CIS when the Criteria of 2010 were applied. The Criteria of 2005 allowed only 70 patients (22%) to be designated as MS. In contrast, the prevalence of OCB was marginal affected in MS patients with 96% for the Criteria of 2010 and 98.5% for the Criteria of 2005. In conclusion, OCB are prevalent in most MS patients and reflect the chronic inflammatory nature of the disease. We recommend CSF examination to exclude alternative diagnoses and reevaluation of the diagnosis MS in patients with negative OCB.
Rogier Q. Hintzen - One of the best experts on this subject based on the ideXlab platform.
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Real-world validation of the 2017 McDonald Criteria for pediatric MS.
Neurology(R) neuroimmunology & neuroinflammation, 2018Co-Authors: Yu Yi M Wong, C. Louk De Mol, Roos M Van Der Vuurst De Vries, E. Daniëlle Van Pelt, Immy A. Ketelslegers, Coriene E. Catsman-berrevoets, Rinze F. Neuteboom, Rogier Q. HintzenAbstract:Objective To compare the diagnostic accuracy of the McDonald 2017 vs the McDonald 2010 Criteria to predict a second attack of MS (clinically definite MS [CDMS]) at the first attack of acquired demyelinating syndromes (ADS). Methods One hundred sixty-four children (aged Results Among the 164 patients, 110 patients (67%) presented without encephalopathy (ADS–, female 63%; median age 14.8 years, IQR 11.3–16.1years) and 54 (33%) with encephalopathy (acute disseminated encephalomyelitis [ADEM], female 52%; median age 4.0 years, IQR 2.6–6.1 years). Of the 110 ADS– patients, 52 (47%) were diagnosed with CDMS within a median follow-up of 4.5 years (IQR 2.6–6.7 years). The sensitivity was higher for the 2017 Criteria than for the 2010 Criteria (83%; 95% CI 67–92, vs 49%; 95% CI 33–65; p p = 0.02). At baseline, 48 patients fulfilled the 2017 Criteria compared with 27 patients when using the 2010 Criteria. The results for children aged Conclusions The McDonald 2017 Criteria are more sensitive than the McDonald 2010 Criteria for predicting CDMS at baseline. These Criteria can also be applied in children aged Classification of evidence This study provides Class II evidence that in children with ADS, the 2017 McDonald Criteria are more sensitive but less specific than the 2010 McDonald Criteria for predicting CDMS.
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Application of the 2017 Revised McDonald Criteria for Multiple Sclerosis to Patients With a Typical Clinically Isolated Syndrome
JAMA neurology, 2018Co-Authors: Roos M Van Der Vuurst De Vries, Yu Yi M Wong, Julia Y Mescheriakova, Tessel F. Runia, Naghmeh Jafari, J. P. A. Samijn, Janet W K De Beukelaar, Beatrijs H. A. Wokke, Theodora A. M. Siepman, Rogier Q. HintzenAbstract:Importance In 2017, the International Panel on Diagnosis of Multiple Sclerosis revised the McDonald 2010 Criteria for the diagnosis of multiple sclerosis (MS). The new Criteria are easier to apply and could lead to more and earlier diagnoses. It is important to validate these Criteria globally for their accuracy in clinical practice. Objective To evaluate the diagnostic accuracy of the 2017 Criteria vs the 2010 Criteria in prediction of clinically definite MS in patients with a typical clinically isolated syndrome (CIS). Design, Setting and Patients A total of 251 patients at Erasmus MC, Rotterdam, the Netherlands, in collaboration with several regional hospitals, fulfilled the inclusion Criteria. Thirteen patients received another diagnosis early in the diagnostic process and therefore were excluded from the analyses. Nine patients with CIS declined to participate in the study. This left 229 patients who were included between March 2006 and August 2016 in this prospective CIS cohort. Patients underwent a baseline magnetic resonance imaging scan within 3 months after onset of symptoms and, if clinically required, a lumbar puncture was performed. Data were analyzed between December 2017 and January 2018. Main Outcomes and Measures Sensitivity, specificity, accuracy, and positive and negative predictive value were calculated after 1, 3, and 5 years for the 2017 vs the 2010 Criteria. Results Among the 229 patients with CIS, 167 were women (73%), and the mean (SD) age was 33.5 (8.2) years. One hundred thirteen patients (49%) were diagnosed as having CDMS during a mean (SD) follow-up time of 65.3 (30.9) months. Sensitivity for the 2017 Criteria was higher than for the 2010 Criteria (68%; 95% CI, 57%-77% vs 36%; 95% CI, 27%-47%;P Conclusions and Relevance The 2017 revised McDonald Criteria are associated with greater sensitivity but less specificity for a second attack than the previous 2010 Criteria. The tradeoff is that it leads to a higher number of MS diagnoses in patients with a less active disease course.
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Spinal cord involvement in Balo's concentric sclerosis.
Journal of the Neurological Sciences, 2009Co-Authors: Karim L Kreft, S Jouke Mellema, Rogier Q. HintzenAbstract:We present a patient with a history of myelitis, who had a steroid refractory attack of CNS inflammatory demyelinating disease that developed into cerebral concentric sclerosis of Balo after plasma exchange. The acute inflammatory disease involved the spinal cord, a phenomenon rarely demonstrated. This patient fulfilled the McDonald Criteria for multiple sclerosis. Plasmapheresis did not have a beneficial effect, but the patient stabilised at high EDSS after treatment with mitoxantron.
Massimo Filippi - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of multiple sclerosis: 2017 revisions of the McDonald Criteria
The Lancet Neurology, 2018Co-Authors: Alan J Thompson, Brenda L. Banwell, Timothy Coetzee, William M Carroll, Jorge Correale, Franz Fazekas, Massimo Filippi, Frederik Barkhof, Giancarlo Comi, Mark S. FreedmanAbstract:The 2010 McDonald Criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald Criteria and recommended revisions. The 2017 McDonald Criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the Criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.
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Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald Criteria: a retrospective study.
The Lancet. Neurology, 2017Co-Authors: Massimo Filippi, Frederik Barkhof, Olga Ciccarelli, Jette L. Frederiksen, Paolo Preziosa, Alessandro Meani, Sarlota Mesaros, Alex Rovira, Christian Enzinger, Claudio GasperiniAbstract:Summary Background In 2016, the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) network proposed modifications to the MRI Criteria to define dissemination in space (DIS) and time (DIT) for the diagnosis of multiple sclerosis in patients with clinically isolated syndrome (CIS). Changes to the DIS definition included removal of the distinction between symptomatic and asymptomatic lesions, increasing the number of lesions needed to define periventricular involvement to three, combining cortical and juxtacortical lesions, and inclusion of optic nerve evaluation. For DIT, removal of the distinction between symptomatic and asymptomatic lesions was suggested. We compared the performance of the 2010 McDonald and 2016 MAGNIMS Criteria for multiple sclerosis diagnosis in a large multicentre cohort of patients with CIS to provide evidence to guide revisions of multiple sclerosis diagnostic Criteria. Methods Brain and spinal cord MRI and optic nerve assessments from patients with typical CIS suggestive of multiple sclerosis done less than 3 months from clinical onset in eight European multiple sclerosis centres were included in this retrospective study. Eligible patients were 16–60 years, and had a first CIS suggestive of CNS demyelination and typical of relapsing-remitting multiple sclerosis, a complete neurological examination, a baseline brain and spinal cord MRI scan obtained less than 3 months from clinical onset, and a follow-up brain scan obtained less than 12 months from CIS onset. We recorded occurrence of a second clinical attack (clinically definite multiple sclerosis) at months 36 and 60. We evaluated MRI Criteria performance for DIS, DIT, and DIS plus DIT with a time-dependent receiver operating characteristic curve analysis. Findings Between June 16, 1995, and Jan 27, 2017, 571 patients with CIS were screened, of whom 368 met all study inclusion Criteria. At the last evaluation (median 50·0 months [IQR 27·0–78·4]), 189 (51%) of 368 patients developed clinically definite multiple sclerosis. At 36 months, the two DIS Criteria showed high sensitivity (2010 McDonald 0·91 [95% CI 0·85–0·94] and 2016 MAGNIMS 0·93 [0·88–0·96]), similar specificity (0·33 [0·25–0·42] and 0·32 [0·24–0·41]), and similar area under the curve values (AUC; 0·62 [0·57–0·67] and 0·63 [0·58–0·67]). Performance was not affected by inclusion of symptomatic lesions (sensitivity 0·92 [0·87–0·96], specificity 0·31 [0·23–0·40], AUC 0·62 [0·57–0·66]) or cortical lesions (sensitivity 0·92 [0·87–0·95], specificity 0·32 [0·24–0·41], AUC 0·62 [0·57–0·67]). Requirement of three periventricular lesions resulted in slightly lower sensitivity (0·85 [0·78–0·90], slightly higher specificity (0·40 [0·32–0·50], and similar AUC (0·63 [0·57–0·68]). Inclusion of optic nerve evaluation resulted in similar sensitivity (0·92 [0·87–0·96]), and slightly lower specificity (0·26 [0·18–0·34]) and AUC (0·59 [0·55–0·64]). AUC values were also similar for DIT (2010 McDonald 0·61 [0·55–0·67] and 2016 MAGNIMS 0·61 [0·55–0·66]) and DIS plus DIT (0·62 [0·56–0·67] and 0·64 [0·58–0·69]). Interpretation The 2016 MAGNIMS Criteria showed similar accuracy to the 2010 McDonald Criteria in predicting the development of clinically definite multiple sclerosis. Inclusion of symptomatic lesions is expected to simplify the clinical use of MRI Criteria without reducing accuracy, and our findings suggest that needing three lesions to define periventricular involvement might slightly increase specificity, suggesting that these two factors could be considered during further revisions of multiple sclerosis diagnostic Criteria. Funding UK MS Society, National Institute for Health Research University College London Hospitals Biomedical Research Centre, Dutch MS Research Foundation.
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Diagnostic Criteria for multiple sclerosis: 2010 Revisions to the McDonald Criteria
Annals of Neurology, 2011Co-Authors: Chris H Polman, Michel Clanet, Kouji Fujihara, Stephen C. Reingold, Jeffrey A. Cohen, Eva Havrdova, Massimo Filippi, Brenda Banwell, Michael Hutchinson, Ludwig KapposAbstract:New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use.
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Will Rogers phenomenon in multiple sclerosis.
Annals of neurology, 2008Co-Authors: Maria Pia Sormani, Massimo Filippi, Alex Rovira, Mar Tintore, Marco Rovaris, Xavier Vidal, Paolo Bruzzi, Xavier MontalbanAbstract:Objective Using different Criteria for classifying patients into various stages of a disease can modify the stage-specific prognosis, even though the overall disease course remains unchanged. This is known as the “Will Rogers phenomenon,” precluding the use of historical controls for treatment trials. We assessed whether the Will Rogers phenomenon may affect multiple sclerosis (MS) prognosis when applying different diagnostic Criteria. Methods Patients with a clinically isolated syndrome (CIS) suggestive of MS were studied. After 1 year, each patient was classified as CIS or evolved to MS according to two diagnostic Criteria (Poser and McDonald). The outcome for prognosis was the time to reach an Expanded Disability Status Scale score ≥ 3.0. Results 309 patients were studied for a median period of 84 months. After 1 year, 16% of patients had MS according to Poser and 44% according to McDonald Criteria. The probability to reach Expanded Disability Status Scale score ≥ 3.0 at median follow-up was 11% in CIS patients according to Poser and 7% according to McDonald Criteria; it was 46% in MS patients according to Poser and 27% acccording to McDonald Criteria. The group with a discordant diagnosis had a worse prognosis than that of CIS patients according to both Criteria (p = 0.01), but better than that of MS patients according to both Criteria (p = 0.01). Interpretation The use of different diagnostic Criteria may generate spurious improvements in the medium-term prognosis of MS. This calls for caution in using historical controls for MS trials. Ann Neurol 2008
Philipp Schwenkenbecher - One of the best experts on this subject based on the ideXlab platform.
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Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing-Remitting Multiple Sclerosis.
Frontiers in neurology, 2019Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Franz Felix Konen, Stefan Gingele, Kurt-wolfram Sühs, Mike P. Wattjes, Martin Stangel, Thomas SkripuletzAbstract:Multiple sclerosis is a chronic immune mediated demyelinating disease leading to neurological disabilities that need to be diagnosed and treated early. Guidelines on multiple sclerosis diagnosis and monitoring experienced comprehensive changes over the last decades. The first McDonald Criteria published in 2001 emphasized the importance of MR imaging but also recognized the role of cerebrospinal fluid diagnostics. The demonstration of an intrathecal immunoglobulin G synthesis is a well-established additional component and has a long tradition in the diagnosis of relapsing-remitting multiple sclerosis. However, the role of cerebrospinal fluid for diagnostic purposes was rather diminished in each revision of the McDonald Criteria. In the latest revision of the McDonald Criteria of 2017, the detection of an intrathecal immunoglobulin G synthesis as oligoclonal bands experienced a revival. Patients with the first clinical event suggesting multiple sclerosis who fulfill the Criteria for dissemination in space can be diagnosed with relapsing-remitting multiple sclerosis when oligoclonal bands in cerebrospinal fluid are detected. The diagnostic sensitivity of these novel Criteria with a focus on dissemination in time and oligoclonal bands as a substitute for dissemination in time was published in different cohorts in the last year and is of special interest in this review. Recently published data show that by applying the 2017 McDonald Criteria, multiple sclerosis can be diagnosed more frequently at the time of first clinical event as compared to the 2010 McDonald Criteria. The main effect was due to the implementation of oligoclonal bands as a substitute for dissemination in time. However, careful differential diagnosis is essential in patients with atypical clinical manifestations to avoid misdiagnoses.
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Clinically Isolated Syndrome According to McDonald 2010: Intrathecal IgG Synthesis Still Predictive for Conversion to Multiple Sclerosis.
International journal of molecular sciences, 2017Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Kurt-wolfram Sühs, Martin Stangel, Anastasia Sarikidi, Paul Bronzlik, Refik Pul, Lena Bönig, Thomas SkripuletzAbstract:While the revised McDonald Criteria of 2010 allow for the diagnosis of multiple sclerosis (MS) in an earlier stage, there is still a need to identify the risk factors for conversion to MS in patients with clinically isolated syndrome (CIS). Since the latest McDonald Criteria were established, the prognostic role of cerebrospinal fluid (CSF) and visual evoked potentials (VEP) in CIS patients is still poorly defined. We conducted a monocentric investigation including patients with CIS in the time from 2010 to 2015. Follow-ups of 120 patients revealed that 42% converted to MS. CIS patients with positive oligoclonal bands (OCB) were more than twice as likely to convert to MS as OCB negative patients (hazard ratio = 2.6). The probability to develop MS was even higher when a quantitative intrathecal IgG synthesis was detected (hazard ratio = 3.8). In patients with OCB, VEP did not add further information concerning the conversion rate to MS. In patients with optic neuritis and negative OCB, a significantly higher rate converted to MS when VEP were delayed. In conclusion, the detection of an intrathecal IgG synthesis increases the conversion probability to MS. Pathological VEP can help to predict the conversion rate to MS in patients with optic neuritis without an intrathecal IgG synthesis.
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McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity
International journal of molecular sciences, 2016Co-Authors: Philipp Schwenkenbecher, Ulrich Wurster, Kurt-wolfram Sühs, Martin Stangel, Anastasia Sarikidi, Paul Bronzlik, Peter Raab, Refik Pul, Thomas SkripuletzAbstract:The 2010 McDonald Criteria were developed to allow a more rapid diagnosis of relapsing-remitting multiple sclerosis (MS) by only one MRI of the brain. Although cerebrospinal fluid (CSF) is not a mandatory part of the latest Criteria, the evidence of an intrathecal humoral immunoreaction in the form of oligoclonal bands (OCB) is crucial in the diagnostic workup. To date, the impact of the 2010 McDonald Criteria on the prevalence of OCB has not been investigated. We retrospectively evaluated data of 325 patients with a clinical relapse suggestive of demyelination that were treated in a German university hospital between 2010 and 2015. One hundred thirty-six patients (42%) were diagnosed with MS and 189 patients with CIS when the Criteria of 2010 were applied. The Criteria of 2005 allowed only 70 patients (22%) to be designated as MS. In contrast, the prevalence of OCB was marginal affected in MS patients with 96% for the Criteria of 2010 and 98.5% for the Criteria of 2005. In conclusion, OCB are prevalent in most MS patients and reflect the chronic inflammatory nature of the disease. We recommend CSF examination to exclude alternative diagnoses and reevaluation of the diagnosis MS in patients with negative OCB.
D H Miller - One of the best experts on this subject based on the ideXlab platform.
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Earlier and more frequent diagnosis of multiple sclerosis using the McDonald Criteria
Journal of neurology neurosurgery and psychiatry, 2014Co-Authors: Wallace J Brownlee, Jk Swanton, Olga Ciccarelli, Daniel R. Altmann, D H MillerAbstract:The McDonald Criteria allow multiple sclerosis (MS) to be diagnosed in patients with a clinically isolated syndrome (CIS) who have MRI evidence of dissemination in time and space.1–3 There have been successive versions of the Criteria in 2001,1 20052 and 20103 with different requirements for dissemination in time and space. Although each version has been shown to have a high sensitivity and specificity for the development of clinically-definite MS (CDMS), few studies have investigated how much sooner4 and how more often5 MS can be diagnosed in patients with CIS using the McDonald Criteria. We recruited 178 patients with CIS presenting to Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery between 1995 and 2004. The study was approved by ethics committees at both hospitals. Patients were seen at baseline, then for follow-up after 3 months, 1 year, 3 years and 6 years. At each study visit informed consent was obtained. Patients were assessed with a detailed review of neurological symptoms and neurological examination. Relapses were recorded at study visits, but patients were also encouraged to contact the research team at the time of new neurological symptoms. MRI of the brain and whole spine was obtained at each visit on the same 1.5 T Signa scanner, as described elsewhere.6 Each scan was reviewed by a neuroradiologist blinded to the patient's clinical status. The number, location and activity (ie, gadolinium enhancement) of T2 lesions was recorded. During follow-up CDMS was defined according …
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MRI Criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study
The Lancet Neurology, 2007Co-Authors: D H MillerAbstract:Summary: Background: The 2001 and 2005 McDonald Criteria allow MRI evidence for dissemination in space (DIS) and dissemination in time (DIT) to be used to diagnose multiple sclerosis in patients who present with clinically isolated syndromes (CIS). In 2006, new Criteria were proposed in which DIS requires at least one T2 lesion in at least two of four locations (juxtacortical, periventricular, infratentorial, and spinal-cord) and DIT requires a new T2 lesion on a follow-up scan. We applied all three Criteria in a large cohort of CIS patients to assess their performance by use of conversion to clinically definite multiple sclerosis (CDMS) as the outcome. Methods: Patients who had two MRI scans within 12 months of CIS onset were identified in four centres in the Magnims European research network. The specificity and sensitivity of MRI Criteria for CDMS after 3 years was assessed in 208 patients. A Cox proportional hazards model was applied in a larger cohort of 282 patients that included all patients irrespective of length of follow-up. Findings: The specificity of all Criteria for CDMS was high (2001 McDonald, 91%; 2005 McDonald, 88%; new, 87%). Sensitivity of the new (72%) and 2005 McDonald (60%) Criteria were higher than the 2001 McDonald Criteria (47%). The Cox proportional hazards model showed a higher conversion risk for all three Criteria in those with both DIS and DIT than those with either DIS or DIT alone. When all three Criteria were included in the model, only the new Criteria had an independent significant effect on conversion risk. Interpretation: The new Criteria are simpler than the McDonald Criteria without compromising specificity and accuracy. The presence of both DIS and DIT from two MRI scans has a higher specificity and risk for CDMS than either DIS or DIT alone.
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Modification of MRI Criteria for multiple sclerosis in patients with clinically isolated syndromes
J NEUROL NEUROSUR PS, 2006Co-Authors: D H MillerAbstract:Background: The McDonald Criteria include MRI evidence for dissemination in space and dissemination in time for the diagnosis of multiple sclerosis in young adult patients who present with clinically isolated syndromes (CIS) typical of the disease. Although a major advance, the Criteria have limited sensitivity for making an early diagnosis.Objective: To compare the performance of McDonald Criteria and modified McDonald Criteria for dissemination in space and time for assessing the development of clinically definite multiple sclerosis.Methods: McDonald Criteria were modified using the combination of a less stringent definition for dissemination in space and allowing a new T2 lesion per se after three months as evidence for dissemination in time. Modified and McDonald Criteria were applied in 90 CIS patients at baseline and at three month follow up scans.Results: Both Criteria were highly specific (> 90%) but the modified Criteria were more sensitive (77% v 46%) and more accurate (86% v 73%).Conclusions: These modified Criteria should be evaluated in other CIS cohorts.
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application of the new McDonald Criteria to patients with clinically isolated syndromes suggestive of multiple sclerosis
Annals of Neurology, 2002Co-Authors: C M Dalton, P A Brex, K A Miszkiel, S J Hickman, David G Macmanus, Gordon T Plant, A J Thompson, D H MillerAbstract:Traditionally, multiple sclerosis (MS) has been diagnosed on the basis of clinical evidence of dissemination in time and space. Previously, it could not be diagnosed in patients with single clinical episodes of demyelination known as clinically isolated syndromes. New diagnostic Criteria from the International Panel of McDonald and colleagues incorporate MRI evidence of dissemination in time and space to allow a diagnosis of MS in patients with clinically isolated syndromes. From clinical and MRI examinations performed prospectively at baseline, 3 months, 1 year, and 3 years of follow-up, the frequency of developing MS was ascertained by the application of both the new McDonald Criteria and the Poser Criteria for clinically definite MS. The specificity, sensitivity, positive and negative predictive value, and accuracy of the new Criteria for the development of clinically definite MS were assessed. At 3 months, 20 of 95 (21%) patients had MS with the McDonald Criteria, whereas only 7 of 95 (7%) had developed clinically definite MS. After 1 year, the corresponding figures were 38 of 79 (48%) and 16 of 79 (20%), and after 3 years, they were 29 of 50 (58%) and 19 of 50 (38%). The development of MS with the new MRI Criteria after 1 year had a high sensitivity (83%), specificity (83%), positive predicative value (75%), negative predictive value (89%), and accuracy (83%) for clinically definite MS at 3 years. Use of the new McDonald Criteria more than doubled the rate of diagnosis of MS within a year of presentation with a clinically isolated syndrome. The high specificity, positive predictive value, and accuracy of the new Criteria for clinically definite MS support their clinical relevance.