Contributions
Abstract: P973
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: The 2010 revised McDonald diagnostic criteria for multiple sclerosis (MS) have been updated in December 2017, in order to anticipate diagnosis and, subsequently, treatment, in clinically isolated syndrome (CIS) patients with a high risk of developing MS.
Objective: The aim of this study is to investigate the performance of the 2010 and 2017 revised McDonald criteria in diagnosing MS in patients with CIS, in a retrospective single-center Italian cohort.
Material and methods: We retrospectively selected patients with a typical CIS suggestive of MS between 2012 and 2017, with at least six months of follow-up, and no history of previous neurological symptoms. Patients were included in the analysis in the presence of baseline cerebrospinal fluid (CSF) analysis, baseline brain and spinal MRI (within 3 months from onset) and a further follow-up brain and spinal scan performed after 3-12 months. Patients who developed primary progressive MS were excluded.
Results: Of 207 selected CIS patients, 129 fulfilled the inclusion criteria and were further analyzed. Mean age at onset was 36 ±11.6 years and female/male ratio was 2.5:1. At onset, a MS diagnosis was possible in 61.3% (n=79) of patients using the 2017 criteria and in 20.8% (n=26) using the 2010 criteria (p < 0.00001). One-hundred and fourteen subjects (88.4%) had dissemination in space (DIS) according to the 2010 criteria, and a further three patients (2.3%) fulfilled the 2017 DIS criteria. Twenty-six (22.8%) patients fulfilled the 2010 DIT criteria, while 2017 DIT criteria were met by a further thirty-four (29.8%) patients using MRI and by further forty-one patients (36%) on the account of CSF oligoclonal bands (OCBs). The median time to MS diagnosis was four months (interquartile range-IQR:1-8 months) following application of the 2010 and one month (IQR:0-2 months) following application of the 2017 criteria (p < 0.001). The proportion of patients with a MS diagnosis using the 2010 and 2017 criteria was 49% and 84%, respectively during the first three months (p < 0,00001) and 81.5% and 96.5% throughout the first year (p =0.0004).
Conclusions: The 2017 McDonald criteria enable a MS diagnosis in more than 80% of CIS patients during the first three months from disease onset. This is mainly due to the reintroduction of CSF OCBs and to the loss of distinction between symptomatic and asymptomatic lesions in the new DIT criteria.
Disclosure: Valentina Camera: nothing to disclose
Diana Ferraro: has served on scientific advisory boards for Biogen Idec, Novartis and Roche and has received travel grants and/or speaking honoraria from Teva, Merck Serono, Genzyme, Biogen and Novartis.
Francesca Vitetta: has served on scientific advisory boards for Merck Serono and Teva and has received travel grants and/or speaking honoraria from Teva, Merck Serono, Genzyme and Biogen.
Roberta Bedin: nothing to disclose
Nicola Fini: nothing to discolse
Paolo Frigio Nichelli: nothing to discolse
Patrizia Sola: has served on scientific advisory boards for Biogen Idec and Teva; she has received funding for travel and speaker honoraria from Biogen Idec, Merck, Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her institution from Bayer, Biogen, Merck, Novartis, Sanofi and Teva.
Abstract: P973
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: The 2010 revised McDonald diagnostic criteria for multiple sclerosis (MS) have been updated in December 2017, in order to anticipate diagnosis and, subsequently, treatment, in clinically isolated syndrome (CIS) patients with a high risk of developing MS.
Objective: The aim of this study is to investigate the performance of the 2010 and 2017 revised McDonald criteria in diagnosing MS in patients with CIS, in a retrospective single-center Italian cohort.
Material and methods: We retrospectively selected patients with a typical CIS suggestive of MS between 2012 and 2017, with at least six months of follow-up, and no history of previous neurological symptoms. Patients were included in the analysis in the presence of baseline cerebrospinal fluid (CSF) analysis, baseline brain and spinal MRI (within 3 months from onset) and a further follow-up brain and spinal scan performed after 3-12 months. Patients who developed primary progressive MS were excluded.
Results: Of 207 selected CIS patients, 129 fulfilled the inclusion criteria and were further analyzed. Mean age at onset was 36 ±11.6 years and female/male ratio was 2.5:1. At onset, a MS diagnosis was possible in 61.3% (n=79) of patients using the 2017 criteria and in 20.8% (n=26) using the 2010 criteria (p < 0.00001). One-hundred and fourteen subjects (88.4%) had dissemination in space (DIS) according to the 2010 criteria, and a further three patients (2.3%) fulfilled the 2017 DIS criteria. Twenty-six (22.8%) patients fulfilled the 2010 DIT criteria, while 2017 DIT criteria were met by a further thirty-four (29.8%) patients using MRI and by further forty-one patients (36%) on the account of CSF oligoclonal bands (OCBs). The median time to MS diagnosis was four months (interquartile range-IQR:1-8 months) following application of the 2010 and one month (IQR:0-2 months) following application of the 2017 criteria (p < 0.001). The proportion of patients with a MS diagnosis using the 2010 and 2017 criteria was 49% and 84%, respectively during the first three months (p < 0,00001) and 81.5% and 96.5% throughout the first year (p =0.0004).
Conclusions: The 2017 McDonald criteria enable a MS diagnosis in more than 80% of CIS patients during the first three months from disease onset. This is mainly due to the reintroduction of CSF OCBs and to the loss of distinction between symptomatic and asymptomatic lesions in the new DIT criteria.
Disclosure: Valentina Camera: nothing to disclose
Diana Ferraro: has served on scientific advisory boards for Biogen Idec, Novartis and Roche and has received travel grants and/or speaking honoraria from Teva, Merck Serono, Genzyme, Biogen and Novartis.
Francesca Vitetta: has served on scientific advisory boards for Merck Serono and Teva and has received travel grants and/or speaking honoraria from Teva, Merck Serono, Genzyme and Biogen.
Roberta Bedin: nothing to disclose
Nicola Fini: nothing to discolse
Paolo Frigio Nichelli: nothing to discolse
Patrizia Sola: has served on scientific advisory boards for Biogen Idec and Teva; she has received funding for travel and speaker honoraria from Biogen Idec, Merck, Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her institution from Bayer, Biogen, Merck, Novartis, Sanofi and Teva.