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

This interesting study from Dublin looked at the sensitivity of the diagnostic criteria for primary progressive MS. They looked at 95 new people with PPMS diagnosed between 1990 and 2011. The group assessed baseline clinical details as well as paraclinical evaluations including MRI brain, spinal cord, cerebrospinal fluid and visually evoked responses (VERs). 88 PPMS patients had at least two diagnostic investigations. Results revealed that the sensitivity of Thompson’s and the McDonald 2001 criteria was 64%, the McDonald 2010 revisions gave the highest sensitivity at 77%, and the McDonald 2005 criteria had intermediate sensitivity at 74%. They found that the combination of CSF oligoclonal bands (CSFOBs) and MRI of the brain yielded the greatest number of patients demonstrating dissemination in space on only two investigations. The diagnostic sensitivity increased to 84% when the number of spinal cord lesions was reduced to one.

Overall, the diagnostic sensitivity for PPMS would increase if an alternative criterion was considered requiring two of the following: 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 of demyelination; iii) CSFOBs would increase the diagnostic sensitivity for PPMS.

Authors: Kelly S, Kinsella K, Duggan M, Tubridy N, McGuigan C, Hutchinson M.

Mult Scler. 2012 Nov 6. [Epub ahead of print]

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