Application of the new McDonald criteria to patients with clinically isolated syndromes suggestive of multiple sclerosis

Abstract

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.

The utility of MRI in suspected MS [RETIRED]

“…17 Rather, the improved diagnostic ability of the new scheme seems to rest entirely upon its use of temporal dissemination criteria. Indeed, the predictive valididy 46 of such criteria for temporal dissemination is established both by these studies 44,45 and by several pieces of class I evidence, as discussed earlier. Moreover, because no alternative diagnosis to MS was made at follow-up in either study, all of the sets of criteria would seem to be equally specific against such a possibility.…”

“…As a result, the findings from both of these studies 44,45 do not support the use of McDonald MRI criteria for dissemination in space (see table 3), which have been consistently found to be less sensitive than either the Paty criteria 33 or the Poser criteria. 17 Rather, the improved diagnostic ability of the new scheme seems to rest entirely upon its use of temporal dissemination criteria.…”

“…44 The clinical diagnosis of MS was made by unblinded physicians who were aware of the (nonquantified) MRI findings (class III evidence). No alternative diagnosis to MS was made or mentioned in the article, although one patient died of an asthmatic attack.…”

Antioxidants and polyunsaturated fatty acids in multiple sclerosis

“…MS is the most frequent neurodegenerative disease in young adults and is currently diagnosed according to the McDonald criteria (Dalton et al, 2002) by using magnetic resonance imaging (MRI) evidence of dissemination of lesions in time and space. MRI is an almost indispensable outcome measure in clinical trials (Van Oosten et al, 2004) that makes clinical research on the effect of dietary compounds complex and expensive.…”

Clinical Profile of Anti-Myelin Oligodendrocyte Glycoprotein Antibody Seropositive Cases of Optic Neuritis

“…9 Multiple sclerosis was diagnosed according to the McDonald criteria revised in 2005. 10 Neuromyelitis optica was diagnosed according to Wingerchuk criteria. 1,2 Visual field was measured by Goldmann kinetic perimeter at the last follow-up.…”