Application of the 2017 McDonald diagnostic criteria for multiple sclerosis in Korean patients with clinically isolated syndrome

Hyun, Jae‐Won; Kim, Woojun; Huh, So Young; Park, Min Su; Ahn, Sanghoon; Cho, Joong-Yang; Kim, Byung Jo; Lee, Sang Hyun; Kim, Su Hyun; Kim, Ho Jin

doi:10.1177/1352458518790702

Cited by 33 publications

(36 citation statements)

References 23 publications

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“…First, these data support the notion that the 2017 McDonald criteria are very successful at marginalizing the diagnosis of CIS and implementing an early diagnosis of RRMS which is well in line with a similar analysis in Asian patients [7]. Whilst cortical lesions as the criterion for DIS and the contribution of symptomatic lesions as well as CSF specific OCBs were both new criteria in the 2017 revision, CSF specific OCBs evolve as the major clinical determinant in everyday practice.…”

Section: Discussionsupporting

confidence: 79%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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Background and purpose For the diagnosis of relapsing–remitting multiple sclerosis (RRMS), the revised 2017 McDonald criteria include cerebrospinal fluid specific oligoclonal bands as a new criterion for dissemination in time. Amongst other things, one expectation of the new criteria is to marginalize the diagnosis of clinically isolated syndrome (CIS), thus allowing for a faster and at the same time still reliable diagnosis of RRMS. Methods In this study, data from an unselected patient cohort with a typical CIS and dissemination in space at a large German Multiple Sclerosis Center from 2013 to 2016 were re‐analysed to compare differences in diagnosing RRMS with the 2017 versus 2010 McDonald criteria in everyday practice. Results Out of a cohort of 290 patients presenting with a typical first demyelinating event, 52% (152 patients) with the diagnosis of RRMS and 48% (138 patients) with the diagnosis of CIS according to the 2010 McDonald criteria were identified. The application of the 2017 McDonald criteria in the same patients increased the number of definite RRMS to 94% (273), thus leaving only 6% of patients with the diagnosis of CIS. The reason for this shift was the presence of cerebrospinal fluid specific oligoclonal bands which was found in 92.7% of the total population and in all patients with 2017 McDonald RRMS. Over a mean follow‐up of 1.5 years, 50% of patients formerly diagnosed with CIS who are now RRMS also fulfilled the 2010 McDonald criteria. Conclusions Our data support the use of the 2017 McDonald criteria for a more sensitive, but not that specific, diagnosis of RRMS in everyday practice.

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Section: Discussionsupporting

confidence: 79%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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“…DIT. Yet the increase in sensitivity of the 2017 criteria was accompanied by a loss in specificity, according to validation studies from different populations (15,41,42). The limited accessibility and lower prevalence of OCB in Asia also interfere with early diagnosis and treatment (7,17).…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, the small sample size may limit the power of our study. The inclusion of 105 patients in the final cohort is mainly due to the low prevalence of MS in China (14,17,28,42), the lack of CSF data in some patients of CIS and the single center nature of our study. Several attempts were made to increase the validity of our results, including the standardized methodology of CSF analysis, the use of multivariate analysis and the employment of bootstrap method for more precise estimation of confidence intervals.…”

Section: Discussionmentioning

confidence: 99%

IgG Index Revisited: Diagnostic Utility and Prognostic Value in Multiple Sclerosis

et al. 2020

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Objective: Early and accurate diagnosis of multiple sclerosis (MS) remains a clinical challenge. The main objective is to evaluate the diagnostic and prognostic value of the routinely performed immunoglobulin G (IgG) index for MS patients in the Asian population. Methods: A retrospective study was conducted among a cohort of clinically isolated syndrome (CIS) patients in China with known oligoclonal band (OCB) status and IgG index at baseline. We first evaluated the predictive value of IgG index for OCB status. Secondly, the diagnostic utility and prognostic value of IgG index alone were tested. Lastly, we incorporated IgG index into the 2017 McDonald criteria by replacing OCB with either "IgG index or OCB" (modified criteria 1), "IgG index and OCB" (modified criteria 2), or "IgG index" (modified criteria 3). The diagnostic utility of different criteria was calculated and compared. Results: In a CIS cohort in China (n = 105), IgG index > 0.7 forecasted OCB positivity (X 2 = 22.90, P < 0.001). An elevated IgG index was highly prognostic of more clinical relapses [1-year adjusted odds ratio [OR] = 1.32, P = 0.015; 2-years adjusted OR = 1.69, P = 0.013] and Expanded Disability Status Scale worsening (1-year adjusted OR = 1.76, P = 0.040; 2-years adjusted OR = 1.85, P = 0.032). Under the 2017 McDonald criteria (Positive Likelihood Ratio = 1.54, Negative Likelihood Ratio = 0.56), an IgG index > 0.7 in CIS patients increased the likelihood of developing MS within 2 years, either when OCB status was unknown (Positive Likelihood Ratio = 2.11) or with OCB positivity (Positive Likelihood Ratio = 2.11) at baseline; An IgG index ≤ 0.7, along with a negative OCB, helped rule out the MS diagnosis (Negative Likelihood Ratio = 0.53). Conclusions: IgG index > 0.7 predicts OCB positivity at the initial attack of MS and is prognostic of early disease activity. IgG index serves as an easily-obtainable and accurate OCB surrogate for MS diagnosis in the Asian population.

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“…The sensitivity was higher for the 2017 criteria than for the 2010 criteria (68 vs. 36%), but the specificity was lower (61 vs. 85%) (10). Hyun and colleagues found similar results when applying the McDonald criteria of 2017 in Korean clinically isolated syndrome patients and described higher sensitivity (88.8%) and accuracy (70.6%) but lower specificity (43.1%) compared with the 2010 McDonald criteria (sensitivity: 53.1%, accuracy 69.2%, specificity 59.5%) for prediction of conversion (54). Again, more clinically isolated syndrome patients could be diagnosed with multiple sclerosis by using the new criteria (76%) as compared to 2010 criteria (44%) (54).…”

Section: Mcdonald Criteriamentioning

confidence: 71%

Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing-Remitting Multiple Sclerosis

et al. 2019

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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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Application of the 2017 McDonald diagnostic criteria for multiple sclerosis in Korean patients with clinically isolated syndrome

Abstract: The 2017 McDonald criteria afforded higher sensitivity and accuracy but lower specificity compared with the 2010 McDonald criteria for prediction of conversion to CDMS in Korean CIS patients.

Cited by 33 publications

References 23 publications

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

IgG Index Revisited: Diagnostic Utility and Prognostic Value in Multiple Sclerosis

Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing-Remitting Multiple Sclerosis

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