Contributions
Abstract: 98
Type: Oral
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: The MAGNIMS group have recent recommended that optic nerve lesions should be included in dissemination in space (DIS) criteria in future revisions of the diagnostic criteria for multiple sclerosis (MS).
Objective: To investigate the impact of (1) inclusion of optic nerve lesions in patients with clinically isolated optic neuritis in DIS and (2) inclusion of asymptomatic optic nerve lesions (detected clinically and/or by visual evoked potentials [VEPs]) in DIS in patients with a non-optic neuritis clinically isolated syndrome (CIS).
Methods: We studied two groups of CIS patients: (1) 129 patients with acute optic neuritis and (2) 29 patients with a non-optic neuritis presentation. MRI scans of the brain and spinal cord within three months of CIS and a follow-up brain MRI after 3-12 months. Involvement of the optic nerve was determined clinically, with VEPs (n=41), or both. Orbital MRI was not done. The patients were followed up prospectively for the development of clinically-definite MS (CDMS) over ~15 years. We retrospectively applied the McDonald 2010 criteria to MRI scans obtained around the time of CIS along with modified DIS criteria that included ON lesions detected clinically or using VEPs. We investigated the performance of the McDonald 2010 criteria and the modified criteria for the development of CDMS.
Results: In the optic neuritis group, inclusion of lesions in the optic nerve identified an additional 15 patients with DIS. The modified DIS criteria (sensitivity/specificity/accuracy 95%/57%/81%) were more sensitive and more accurate than the McDonald 2010 DIS criteria (83%/68%/78%), but less specific. When DIS criteria were combined with DIT the modified criteria (83%/77%/81%) were still more sensitive and the specificity was the same as the McDonald 2010 criteria (74%/77%/75%). In the non-optic neuritis group, 3 (10.3%) patients had involvement of the optic nerve (1/29 optic disc pallor, 3/15 abnormal VEPs). Inclusion of optic nerve lesions in DIS did not identify any additional patients, and the performance of the modified DIS criteria and the McDonald 2010 was the same.
Conclusion: In patients with optic neuritis, inclusion of clinically and/or VEP manifest symptomatic optic nerve lesions in DIS improved the overall performance of diagnostic criteria for MS (requiring both DIS and DIT). The utility of including asymptomatic optic nerve lesions in patients with a non-optic neuritis CIS should be investigated in larger cohorts.
Disclosure:
W Brownlee is supported by the Neurological Foundation of New Zealand and the UK MS Society.
D Altmann has nothing to disclose.
K Miszkiel has nothing to disclose.
F Barkhof acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck-Serono, Roche, Novartis, Genzyme, and Sanofi-Aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, MSJ, Neurology.
D Miller has received honoraria through payments to UCL Institute of Neurology for Advisory Committee and/or Consultancy advice in multiple sclerosis studies from Novartis and Mitsubishi Pharma Europe and compensation through payments to UCL Institute of Neurology for performing central MRI analysis of a multiple sclerosis trial from Novartis.
O Ciccarelli receives research grant support from the Multiple Sclerosis Society of Great Britain and Northern Ireland, the NIHR UCLH Biomedical Research Centre; she is a consultant for Teva, Roche, Novartis, Biogen, Genzyme and GE. She is an Associate Editor for Neurology, for which she receives an honorarium.
Abstract: 98
Type: Oral
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: The MAGNIMS group have recent recommended that optic nerve lesions should be included in dissemination in space (DIS) criteria in future revisions of the diagnostic criteria for multiple sclerosis (MS).
Objective: To investigate the impact of (1) inclusion of optic nerve lesions in patients with clinically isolated optic neuritis in DIS and (2) inclusion of asymptomatic optic nerve lesions (detected clinically and/or by visual evoked potentials [VEPs]) in DIS in patients with a non-optic neuritis clinically isolated syndrome (CIS).
Methods: We studied two groups of CIS patients: (1) 129 patients with acute optic neuritis and (2) 29 patients with a non-optic neuritis presentation. MRI scans of the brain and spinal cord within three months of CIS and a follow-up brain MRI after 3-12 months. Involvement of the optic nerve was determined clinically, with VEPs (n=41), or both. Orbital MRI was not done. The patients were followed up prospectively for the development of clinically-definite MS (CDMS) over ~15 years. We retrospectively applied the McDonald 2010 criteria to MRI scans obtained around the time of CIS along with modified DIS criteria that included ON lesions detected clinically or using VEPs. We investigated the performance of the McDonald 2010 criteria and the modified criteria for the development of CDMS.
Results: In the optic neuritis group, inclusion of lesions in the optic nerve identified an additional 15 patients with DIS. The modified DIS criteria (sensitivity/specificity/accuracy 95%/57%/81%) were more sensitive and more accurate than the McDonald 2010 DIS criteria (83%/68%/78%), but less specific. When DIS criteria were combined with DIT the modified criteria (83%/77%/81%) were still more sensitive and the specificity was the same as the McDonald 2010 criteria (74%/77%/75%). In the non-optic neuritis group, 3 (10.3%) patients had involvement of the optic nerve (1/29 optic disc pallor, 3/15 abnormal VEPs). Inclusion of optic nerve lesions in DIS did not identify any additional patients, and the performance of the modified DIS criteria and the McDonald 2010 was the same.
Conclusion: In patients with optic neuritis, inclusion of clinically and/or VEP manifest symptomatic optic nerve lesions in DIS improved the overall performance of diagnostic criteria for MS (requiring both DIS and DIT). The utility of including asymptomatic optic nerve lesions in patients with a non-optic neuritis CIS should be investigated in larger cohorts.
Disclosure:
W Brownlee is supported by the Neurological Foundation of New Zealand and the UK MS Society.
D Altmann has nothing to disclose.
K Miszkiel has nothing to disclose.
F Barkhof acts as a consultant to Biogen-Idec, Janssen Alzheimer Immunotherapy, Bayer-Schering, Merck-Serono, Roche, Novartis, Genzyme, and Sanofi-Aventis. He has received sponsorship from EU-H2020, NWO, SMSR, EU-FP7, TEVA, Novartis, Toshiba. He is on the editorial board of Radiology, Brain, Neuroradiology, MSJ, Neurology.
D Miller has received honoraria through payments to UCL Institute of Neurology for Advisory Committee and/or Consultancy advice in multiple sclerosis studies from Novartis and Mitsubishi Pharma Europe and compensation through payments to UCL Institute of Neurology for performing central MRI analysis of a multiple sclerosis trial from Novartis.
O Ciccarelli receives research grant support from the Multiple Sclerosis Society of Great Britain and Northern Ireland, the NIHR UCLH Biomedical Research Centre; she is a consultant for Teva, Roche, Novartis, Biogen, Genzyme and GE. She is an Associate Editor for Neurology, for which she receives an honorarium.