Multiple sclerosis diagnostic criteria: from Poser to the 2017 revised McDonald criteria

New diagnostic criteria for multiple sclerosis (MS) have been proposed by Swanton and co authors, but were not yet evaluated in patients suspected of MS, but diagnosed with another disease. The dissemination in space (DIS) criterion of these Swanton criteria was investigated in such a patient group and compared with the present McDonald criteria. We found that with the Swanton criteria for DIS, simplicity can be combined with some gain in sensitivity, without major loss of specificity.

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Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”

Annals of Neurology ◽

10.1002/ana.20703 ◽

2005 ◽

Vol 58 (6) ◽

pp. 840-846 ◽

Cited By ~ 3371

Author(s):

Chris H. Polman ◽

Stephen C. Reingold ◽

Gilles Edan ◽

Massimo Filippi ◽

Hans-Peter Hartung ◽

...

Keyword(s):

Multiple Sclerosis ◽

Diagnostic Criteria ◽

Mcdonald Criteria

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A proposed modification to the McDonald 2010 criteria for the diagnosis of primary progressive multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458512464829 ◽

2012 ◽

Vol 19 (8) ◽

pp. 1095-1100 ◽

Cited By ~ 21

Author(s):

SB Kelly ◽

K Kinsella ◽

M Duggan ◽

N Tubridy ◽

C McGuigan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Diagnostic Criteria ◽

Progressive Multiple Sclerosis ◽

Diagnostic Sensitivity ◽

Oligoclonal Bands ◽

Primary Progressive Multiple Sclerosis ◽

Primary Progressive ◽

Mcdonald Criteria ◽

The Brain

Background: The diagnostic criteria for primary–progressive multiple sclerosis (PPMS) have undergone revision over the last 20 years. Cerebrospinal fluid oligoclonal bands (CSFOBs) have received less emphasis in recent revisions of the McDonald criteria. The aim of this study was to examine the sensitivity of the diagnostic criteria for PPMS with particular reference to spinal cord criteria and examine the utility of CSFOBs in a cohort of PPMS patients. Methods: All new PPMS diagnoses between 1990 and 2011 were identified. Baseline clinical details and paraclinical evaluations including MRI of the brain, spinal cord, CSF and visually evoked responses (VERs) were assessed. The proportion of patients who met the requirements for diagnosis of PPMS on the basis of Thompson’s and the McDonald Criteria (2001, 2005, 2010) were determined. Results: There were 88/95 PPMS patients who had at least two diagnostic investigations. The sensitivity of Thompson’s and the McDonald 2001 criteria was 64%; the McDonald 2010 revisions gave the highest sensitivity (77%); the McDonald 2005 criteria had intermediate sensitivity (74%). The combination of CSFOBs and MRI of the brain yielded the greatest number of patients demonstrating dissemination in space (DIS) on only two investigations. VERs did not aid diagnosis. Reducing requirements for the number of spinal cord lesions (symptomatic or not) to one increased diagnostic sensitivity to 84%. Conclusion: An alternative criterion requiring two of: i) MRI of the brain with one or more lesions in two of three regions typical for demyelination; ii) the presence of one T2-weighted spinal cord plaque (typical for demyelination); iii) CSFOBs; would increase the diagnostic sensitivity for PPMS.

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Primary progressive multiple sclerosis diagnostic criteria: a reappraisal

Multiple Sclerosis Journal ◽

10.1177/1352458509348422 ◽

2009 ◽

Vol 15 (12) ◽

pp. 1459-1465 ◽

Cited By ~ 24

Author(s):

X. Montalban ◽

J. Sastre-Garriga ◽

M. Filippi ◽

Z. Khaleeli ◽

N. Téllez ◽

...

Keyword(s):

Multiple Sclerosis ◽

Diagnostic Criteria ◽

Disease Duration ◽

Progressive Multiple Sclerosis ◽

Added Value ◽

Oligoclonal Bands ◽

Primary Progressive Multiple Sclerosis ◽

Primary Progressive ◽

Mcdonald Criteria ◽

Relapsing Remitting

The diagnostic criteria used in primary progressive (PP) and relapsing—remitting (RR) multiple sclerosis (MS) show substantial differences. This introduces complexity in the diagnosis of MS which could be resolved if these criteria could be unified in terms of the requirements for dissemination in space (DIS). The aim of this study was to assess whether a single algorithm may be used to demonstrate DIS in all forms of MS. Five sets of RRMS criteria for DIS were applied to a cohort of 145 patients with established PPMS (mean disease duration: 11 years — PPMS-1): C1: Barkhof—Tintoré (as in 2005 McDonald’s criteria); C2: Swanton et al. (as in JNNP 2006); C3: presence of oligoclonal bands plus two lesions (as in McDonald’s criteria); C4 and C5: a two-step approach was also followed (patients not fulfilling C1 or C2 were then assessed for C3). Two sets of PPMS criteria for DIS were applied: C6: Thompson et al. (as in 2001 McDonald’s criteria); C7: 2005 McDonald criteria. A second sample of 55 patients with less than 5 years of disease duration (PPMS-2) was also analysed using an identical approach. For PPMS-1/PPMS-2, fulfilment was: C1:73.8%/66.7%; C2:72.1%/59.3%; C3:89%/79.2%; C4:96%/92.3%; C5:96%/85.7%; C6:85.8%/78.7%; C7:91%/80.4%. Levels of fulfilment suggest that the use of a single set of criteria for DIS in RRMS and PPMS might be feasible, and reinforce the added value of cerebrospinal fluid (CSF) findings to increase fulfilment in PPMS. Unification of the DIS criteria for both RRMS and PPMS could be considered in further revisions of the MS diagnostic criteria.

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Three-Tesla MRI does not improve the diagnosis of multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000005825 ◽

2018 ◽

Vol 91 (3) ◽

pp. e249-e257 ◽

Cited By ~ 11

Author(s):

Marloes H.J. Hagens ◽

Jessica Burggraaff ◽

Iris D. Kilsdonk ◽

Marlieke L. de Vos ◽

Niamh Cawley ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Diagnostic Criteria ◽

Brain Mri ◽

White Matter Lesions ◽

Lesion Detection ◽

Mcdonald Criteria ◽

Number Of Patients ◽

Work Up ◽

Three Tesla

ObjectiveIn the work-up of patients presenting with a clinically isolated syndrome (CIS), 3T MRI might offer a higher lesion detection than 1.5T, but it remains unclear whether this affects the fulfilment of the diagnostic criteria for multiple sclerosis (MS).MethodsWe recruited 66 patients with CIS within 6 months from symptom onset and 26 healthy controls in 6 MS centers. All participants underwent 1.5T and 3T brain and spinal cord MRI at baseline according to local optimized protocols and the MAGNIMS guidelines. Patients who had not converted to MS during follow-up received repeat brain MRI at 3–6 months and 12–15 months. The number of lesions per anatomical region was scored by 3 raters in consensus. Criteria for dissemination in space (DIS) and dissemination in time (DIT) were determined according to the 2017 revisions of the McDonald criteria.ResultsThree-Tesla MRI detected 15% more T2 brain lesions compared to 1.5T (p < 0.001), which was driven by an increase in baseline detection of periventricular (12%, p = 0.015), (juxta)cortical (21%, p = 0.005), and deep white matter lesions (21%, p < 0.001). The detection rate of spinal cord lesions and gadolinium-enhancing lesions did not differ between field strengths. Three-Tesla MRI did not lead to a higher number of patients fulfilling the criteria for DIS or DIT, or subsequent diagnosis of MS, at any of the 3 time points.ConclusionScanning at 3T does not influence the diagnosis of MS according to McDonald diagnostic criteria.

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P.028 Each revision of the McDonald diagnostic criteria for multiple sclerosis allow earlier diagnosis in more patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.130 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S23-S23

Author(s):

Y Mahjoub ◽

LM Metz ◽

Keyword(s):

Multiple Sclerosis ◽

Clinical Trial ◽

Diagnostic Criteria ◽

Clinical Diagnosis ◽

Transverse Myelitis ◽

Imaging Data ◽

Mcdonald Criteria ◽

Clinical Onset ◽

Spinal Lesion ◽

The Impact

Background: The 2005, 2010, and 2017 McDonald diagnostic criteria for multiple sclerosis (MS) were compared at baseline in participants of a Canadian multicentre clinical trial of minocycline in clinically isolated syndrome (CIS). Methods: The cohort included 142 participants. Baseline clinical and imaging data were used to determine if participants met criteria for dissemination in space (DIS) and time (DIT) as required for each version of the criteria. We also explored the impact of permitting a clinical diagnosis of transverse myelitis to represent a spinal cord lesion, and for multifocal clinical onset to represent DIS. Results: The clinical trial excluded patients meeting the 2005 McDonald criteria at baseline. The 2010 criteria were met by 28.9% (41/142) of participants. If a multifocal clinical presentation was considered evidence of DIS 29.6% (42/142) met the 2010 criteria. The 2017 criteria were met by 36.7% (52/142). Allowing a clinical diagnosis of transverse myelitis to confirm a spinal lesion, or multifocal onset to confirm evidence of DIS, led to a diagnosis in 38% (54/142) and 38.7% (55/142), respectively. Conclusions: This study confirms that each revision of the McDonald diagnostic criteria allowed an MS diagnosis in more CIS patients at onset. Exploration of other modifications suggests further improvement may be possible.

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Primary progressive multiple sclerosis: a comparative study of the diagnostic criteria

Multiple Sclerosis Journal ◽

10.1177/1352458506071767 ◽

2007 ◽

Vol 13 (5) ◽

pp. 622-625 ◽

Cited By ~ 11

Author(s):

J. de Seze ◽

M. Debouverie ◽

N. Waucquier ◽

G. Steinmetz ◽

S. Pittion ◽

...

Keyword(s):

Multiple Sclerosis ◽

Comparative Study ◽

Diagnostic Criteria ◽

Progressive Multiple Sclerosis ◽

Primary Progressive Multiple Sclerosis ◽

Primary Progressive ◽

Mcdonald Criteria

We assessed the different sets of diagnostic criteria for primary progressive multiple sclerosis (PPMS), in order to determine their sensitivity when applied to a cohort of 261 PPMS patients. According to the Thompson criteria, 168 patients (64.4%) had definite PPMS, 84 patients (32.2%) had probable PPMS, and nine patients (3.4%) had possible PPMS; according to the McDonald criteria, 180 patients (69%) had PPMS; according to the revised McDonald criteria, 194 patients (74.3%) had PPMS. Our findings indicate that the revised McDonald criteria are more sensitive than the original McDonald criteria, but less sensitive than the Thompson criteria. Multiple Sclerosis 2007; 13: 622-625. http://msj.sagepub.com

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Misdiagnosis of multiple sclerosis

Neurology ◽

10.1212/wnl.0000000000006583 ◽

2018 ◽

Vol 92 (1) ◽

pp. 26-33 ◽

Cited By ~ 29

Author(s):

Andrew J. Solomon ◽

Robert T. Naismith ◽

Anne H. Cross

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Clinical Practice ◽

Diagnostic Criteria ◽

Validation Studies ◽

Oligoclonal Bands ◽

Cortical Lesions ◽

Mcdonald Criteria ◽

Clinical Presentations

Misdiagnosis of multiple sclerosis (MS) (the incorrect assignment of a diagnosis of MS) remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity. The recently published 2017 revision of the McDonald criteria for the diagnosis of MS provides an opportunity to consider the effect of these revisions on the problem of MS misdiagnosis. The 2017 McDonald criteria include several new recommendations to reduce potential for misdiagnoses. The criteria should be used for the types of patients in which validation studies were performed, specifically those patients who present with typical demyelinating syndromes. MRI lesion characteristics were defined for which McDonald criteria would be expected to perform with accuracy. However, 2017 revisions, which now include assessment for cortical lesions, and the inclusion of symptomatic lesions and positive oligoclonal bands for the fulfillment of diagnostic criteria, may have the potential to lead to misdiagnosis of MS if not applied appropriately. While the 2017 McDonald criteria integrate issues relating to MS misdiagnosis and incorporate specific recommendations for its prevention more prominently than prior criteria, the interpretation of clinical and radiologic assessments upon which these criteria depend will continue to allow misdiagnoses. In patients with atypical clinical presentations, the revised McDonald criteria may not be readily applied. In those situations, further evaluation or monitoring rather than immediate diagnosis of MS is prudent.

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Radiologically isolated syndrome is antiquated amidst evolving McDonald criteria for multiple sclerosis

CNS Spectrums ◽

10.1017/s1092852919001202 ◽

2019 ◽

pp. 1-3

Author(s):

Jagannadha Avasarala ◽

Fawad Yousuf

Keyword(s):

Multiple Sclerosis ◽

Optic Nerve ◽

Diagnostic Criteria ◽

Mcdonald Criteria ◽

Radiologically Isolated Syndrome ◽

Nerve Involvement ◽

Appropriate Treatment ◽

Modern Era ◽

Optic Nerve Involvement

The diagnosis of radiologically isolated syndrome (RIS) is untenable in the modern era as new diagnostic criteria for multiple sclerosis (MS) continue to evolve. Even without optic nerve involvement, the shift in the diagnostic criteria for MS forces clinicians to make a diagnosis at the earliest possible time and appropriate treatment initiated. In this analysis, we revisit the original RIS criteria as published and conclude that RIS as a diagnostic entity is obsolete.

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