Today, I visited the MSIF website and discovered an article about the changes in MS diagnostic criteria. The revisions simplify the commonly-used criteria which will lead to faster diagnoses. The article states:
An international panel of experts chaired by Dr Chris Polman has revised and simplified the 'McDonald Criteria' commonly used to diagnose multiple sclerosis, incorporating new data that should speed the diagnosis without compromising accuracy. The publication in Annals of Neurology of the revised Criteria follows a meeting of the panel held in Dublin, Ireland, in May 2010.The NMSS also reported on this; their article goes into a little more detail. Regarding the McDonald Criteria "basics" and the revisions, excerpts from the article state the following:
The McDonald Criteria for Diagnosis of MS were originally published in 2001, and were named for the chair of the original panel, the late Professor Ian McDonald, a world leader in MS research and former Chairman of MSIF’s International Medical and Scientific Board (IMSB).
Dr. Polman, also a member of the IMSB, also chaired the panel responsible for the 2005 revisions to the McDonald MS diagnostic criteria.
The McDonald criteria were originally developed using data gathered largely from adult Caucasian European and North American populations.
Since their applicability to other populations has been questioned, the panel also considered how well the McDonald Criteria can be applied to specific populations such as childhood MS, and Asian and Latin American populations.
They concluded that the 2010 Revised Criteria would apply to the majority of these populations, but the paper describes specific situations in which further considerations and tests would be recommended to properly diagnose MS in these groups.
Diagnosis of MS - The Basics Still Apply: The diagnosis of MS is a partly subjective process, and is best made by an expert who is familiar with the disease and who can interpret imaging and laboratory evidence that can supplement the clinical diagnostic process. The requirement remains that there must be no better explanation than MS for the clinical and laboratory findings – other possible diagnoses must be considered and excluded. (Read more here)
The key to an MS diagnosis has been, and remains, the objective demonstration of dissemination of typical disease signs and symptoms in time and space. The 2010 revisions maintain this requirement, but offer several ways of using imaging to determine dissemination. It remains the case that while the use of paraclinical and laboratory examination can speed an MS diagnosis, a solid diagnosis can be made on clinical grounds alone.
No single test can provide adequate information to support an MS diagnosis. Therefore, supportive and confirmatory paraclinical examinations – including analysis of lesions by MRI, of cerebrospinal fluid (CSF), and sometimes of evoked potentials – are still important in helping to confirm an MS diagnosis.
What Has Changed: There is new emphasis that the McDonald Criteria should only be applied to those who present with a clinically isolated syndrome (CIS) suggestive of MS, or who have symptoms consistent with a central nervous system inflammatory demyelinating disease. The panel also considered how well the Criteria can be applied to specific populations such as childhood MS (pediatric MS) and Asian and Latin American populations. They concluded that the 2010 Revised Criteria would apply to the majority of these populations, but the paper describes specific situations in which further considerations and tests would be recommended to properly diagnose MS in these groups.
In past versions of the McDonald Criteria, guidelines were presented for using MRI to demonstrate dissemination of disease in time and space, based on earlier studies. For the 2010 Revised Criteria, published recommendations from the European MAGNIMS multicenter collaboration have been incorporated (Swanton JK, Rovira A, Tintoré M, et al. Lancet Neurol 2007;6:677-686; Swanton JK Fernando K, Dalton CM, et al. J Neurol Neurosurg Psychiatry 2006;77:830-833.) These indicate that:
In the case of diagnosing primary-progressive MS, aspects of the previous criteria remain, but the MAGNIMS recommendations for demonstrating dissemination in space were incorporated to harmonize with other 2010 updates. As shown in Table 1, diagnosing primary-progressive MS requires one year of disease progression (determined retrospectively or prospectively), plus at least 2 out of these 3 criteria: dissemination in space in the brain based on at least 1 T2 lesion in periventricular, juxtacortical or infratentorial regions; dissemination in space in the spinal cord based on at least 2 T2 lesions; or positive cerebrospinal fluid (CSF) findings.
- Dissemination in time can be demonstrated by a new T2 or gadolinium-enhancing lesion on a follow-up MRI, with reference to a baseline scan, regardless of when the baseline MRI was obtained. (Previous versions had specified that the reference scan be performed at least 30 days after the initial clinical event; this is no longer a requirement.)
- Dissemination in space can be demonstrated with at least one T2 lesion in at least two our of four areas of the central nervous system: periventricular, juxtacortical, infratentorial, or spinal cord. These lesions need not be gadolinium enhanced.
While the International Panel has provided revised and simplified criteria for MS diagnosis, recommendations for further testing of the Criteria are made as well, to bolster the scientific evidence supporting the 2010 recommendations.
So, in simplifying the criteria and making an MS diagnosis quicker, is that a good thing or a bad thing? On the one hand, people diagnosed may be able to get on therapy quicker. But, on the other hand, does this open us up to misdiagnoses? That is the question. Thoughts?
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