A STUDY evaluating the application of the 2017 McDonald criteria for diagnosing multiple sclerosis (MS) has shown that the criteria work effectively across both relapsing-remitting and primary progressive MS, supporting the feasibility of a unified diagnostic approach.
Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system. Diagnosing the disease can be challenging, particularly in cases of primary progressive MS (PPMS), where symptoms gradually worsen without clear relapse episodes. The 2017 McDonald criteria for MS distinguish between relapsing-remitting multiple sclerosis (RRMS) and PPMS, but recent studies have suggested the potential benefits of consolidating these criteria into one unified set. This study aimed to assess the effectiveness of the 2017 McDonald RRMS criteria in diagnosing suspected PPMS across five European centres.
The study involved a retrospective analysis of 282 patients diagnosed with PPMS using the 2017 McDonald criteria and compared this to other diagnostic methods. The researchers evaluated the standard RRMS dissemination in space (DIS) and dissemination in time (DIT) criteria, alongside modified RRMS criteria that included optic nerve lesions and ≥2 spinal cord lesions. The findings showed that the RRMS criteria, when used with either cerebrospinal fluid (CSF) analysis or MRI evidence of DIT, demonstrated high sensitivity (92.9–95.4%), specificity (95%), and accuracy (93.2–95.3%) for diagnosing PPMS. The proposed diagnostic algorithm for PPMS patients, based on these criteria, demonstrated the potential for simplifying diagnosis across MS types.
The results of this study suggest that integrating RRMS diagnostic criteria into PPMS diagnostics is not only feasible but could offer significant advantages, including simplifying the diagnostic process and reducing misdiagnosis. This approach could be particularly beneficial in clinical practice, as it would streamline the diagnosis of MS patients, regardless of disease course. Future research should focus on further validating these unified criteria, testing their applicability in relapse-onset MS, and exploring the integration of novel diagnostic biomarkers.
Katrina Thornber, EMJ
Reference
Brownlee WJ, Vidal-Jordana A, Shatila M, et al. Towards a unified set of diagnostic criteria for multiple sclerosis. Ann Neurol. 2024;DOI:10.1002/ana.27145.
