Periventricular lesions and MS diagnostic criteria in young adults with typical clinically isolated syndromes

Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study

“…In a recent study, 3 PV lesions improved specificity in older CIS patients. 27 In line with this evidence and with that of a recent 15-year FU study, 13 our results suggested that the use of 3 lesions to define PV involvement slightly reduced sensitivity (0.85 vs 0.91 at M36), but slightly increased specificity (0.40 vs 0.33 at M36), without affecting diagnostic accuracy. Given the increased risk of misdiagnosis due to an oversimplification of MS diagnostic criteria, there is the need to consider features which could be more distinctive for this condition compared to other diseases.…”

“…For both sets of criteria, specificity was lower than that of previous studies that evaluated the diagnostic performance of the McDonald 2010 criteria. 6,7,13,19 Several factors may help to explain the current findings, including the different FU durations, 6,13 the methods used for the statistical analysis (using a time-to-event analysis in the current study), and the influence of treatment, which may have delayed or prevented the occurrence of the second attack during the study period.…”

“…This, together with expert consensus, resulted in the MAGNIMS 2016 criteria. 5 Modifications to the DIS criteria 5 were: 1) the removal of any distinction between symptomatic and asymptomatic lesions; 6, 7 2) increasing from 1 to 3 in the number of lesions needed to establish periventricular (PV) involvement; [8][9][10][11][12][13] 3) combining cortical lesions (CL) (confined to the cortex without involving the underlying subcortical white matter [WM]) and juxtacortical lesions (JC) (contiguous to the gray matter [GM], and mixed WM/GM) to expand the concept of JC involvement; 14 and 4) including the optic nerve (ON) as an additional location for DIS definition. [15][16][17] Removing the distinction between symptomatic and asymptomatic lesions and inclusion of any new/active lesion were suggested for DIT criteria.…”

Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

“…7 In a recent analysis, changing the requirement from one periventricular lesion to three improved specificity of DIS from 0.37 to 0.46 but decreased sensitivity from 0.88 to 0.83. 72 The Panel felt the modest improvement in specificity, comparable to that achieved when DIS and DIT are considered in combination, 79,80 did not justify the added complexity of requiring a different number of lesions in different anatomic regions. Therefore, the Panel recommended the 2017 McDonald Criteria maintain the requirement for one periventricular lesion.…”

Cortico-juxtacortical and periventricular lesions and MS diagnostic criteria

“…6 A recent investigation showed that in young adult patients with a typical CIS, increasing the required number of periventricular lesions to 3 did not improve diagnostic accuracy, and, when combined with DIT, did not reduce specificity. 7 In this issue of Neurology ® , Arrambide et al 8 have provided conclusive evidence for combining cortical and juxtacortical lesions in a single term (cortical-juxtacortical lesions) and for maintaining the criterion of at least 1 periventricular lesion. The authors have studied a large cohort of patients with CIS over more than 10 years at the Vall d'Hebron University Hospital in Barcelona.…”