McDonald Criteria Allow Earlier Diagnosis of Multiple Sclerosis

By Reuters Staff

NEW YORK (Reuters Health) - Using the McDonald criteria can allow earlier diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS), researchers from the UK report.

The McDonald criteria allow diagnosis of MS in patients with CIS who have MRI evidence of dissemination in time and space. Few studies have examined how much sooner and how more often MS is diagnosed using the criteria, Dr. Wallace J. Brownlee from UCL Institute of Neurology in London and colleagues note in the Journal of Neurology, Neurosurgery, and Psychiatry, online November 20.

The team retrospectively applied the McDonald criteria (versions 2001, 2005, and 2010) to 157 patients with CIS to determine times to MS diagnosis by each diagnostic criterion.

Seventy-one patients (45%) were classified as clinically-definite MS (CDMS) after a mean time of 12.0 months (2001), 10.5 months (2005), and 6.2 months (2010), compared with a mean time to diagnosis of 23.1 months using the Poser criteria (p<0.0001).

Among 86 patients who did not have a second clinical attack, 28%, 30% and 42% satisfied 2001, 2005, and 2010 McDonald criteria, respectively, with MRI evidence of dissemination in time and space, i.e., MRI-only MS, the researchers say.

Fifty patients (32%) were left without an MS diagnosis using the 2010 McDonald criteria after six years.

"Establishing a diagnosis of MS at an earlier time point provides an explanation for worrying symptoms and allows for timely discussions about the nature of MS and its management, including use of disease-modifying treatments," the researchers say. "In this large CIS cohort, MS was diagnosed significantly earlier using the McDonald criteria."

"While the McDonald criteria facilitate an earlier diagnosis of MS, up to a third of patients with CIS who satisfy the 2010 criteria do not have further clinical events, at least in the medium-term," they add.

SOURCE: https://bit.ly/1tmndZi

J Neurol Neurosurg Psychiatry 2014.

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