Revised McDonald Criteria Allow Substitution for Dissemination in Time
MAGNIMS Proposal
Several proposals generated discussion during the panel meetings but were not adopted, primarily because the evidence did not justify changing the current criteria. For instance, the 2016 MAGNIMS MRI criteria propose that the number of acquired periventricular lesions be increased from one to three to provide additional specificity. “We reviewed those data … and felt that the modest increase in specificity did not justify making the change,” Dr. Cohen said. The panel also discussed incorporating optic nerve involvement into the criteria, but this proposal was not included in the update.
“The 2017 revisions further refine the well-established McDonald criteria,” Dr. Cohen said. “The appropriate application of the criteria is critical to avoid misdiagnosis. Fundamentally, MS remains a clinical diagnosis. … It requires rigorous synthesis of clinical, imaging, and laboratory data by a clinician with expertise in MS.”
Making a Diagnosis Sooner
Neurologists have been diagnosing MS in patients sooner. At the same time, misdiagnosing other conditions as MS can have profound consequences, including the potentially serious side effects of disease-modifying therapy, said Jeremy Chataway, PhD, consultant neurologist at the National Hospital for Neurology and Neurosurgery, London, in a lecture about the application of the proposed criteria. He described cases in which the 2017 proposed criteria—by allowing the inclusion of a symptomatic spinal cord lesion, or by substituting CSF-specific oligoclonal bands in place of dissemination in time—would have allowed neurologists to diagnose MS sooner. In one case, a patient might have received a diagnosis of MS about two years earlier.
Sometimes a diagnosis of MS “is obvious,” Dr. Chataway said. “Sometimes it is hard, even with advanced MRI. You can see the gradation that is required … to get us to the correct diagnosis.”
—Jake Remaly
Suggested Reading
Lublin FD, Reingold SC, Cohen JA, et al. Defining the clinical course of multiple sclerosis: the 2013 revisions. Neurology. 2014;83(3):278-286.
Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011;69(2):292-302.
Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. Neurology. 2016;87(13):1393-1399.
