Contributions
Abstract: 140
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and objective: Recently, the International Panel on Diagnosis of Multiple Sclerosis revised the McDonald 2010 criteria for the diagnosis of multiple sclerosis (MS). The new criteria are easier to apply and could lead to more and earlier diagnoses. It is important to validate these criteria globally for their accuracy in clinical practice.
Our aim was to evaluate the diagnostic accuracy of the McDonald 2017 criteria versus the 2010 criteria to predict clinically definite MS (CDMS) in patients with a typical clinically isolated syndrome (CIS).
Methods: We included 229 patients between March 2006 and August 2016 in this prospective CIS cohort. Patients underwent a baseline MRI scan within three months after onset of symptoms and, if clinically required, a lumbar puncture was performed. CDMS was used as the gold standard for MS diagnosis. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated after 1, 3 and 5 years for the 2017 versus the 2010 criteria.
Results: Among the 229 CIS patients, 167 were female (73%). The mean (SD) age was 33.5 (8.2) years. Hundred and thirteen patients (49%) were diagnosed with CDMS during a mean (SD) follow-up time of 65.3 (30.9) months. Sensitivity for the 2017 criteria was higher than for the 2010 criteria (68% vs 36%; p< 0.001), but specificity was lower (61% vs 85%; p< 0.001). Using the 2017 criteria more MS diagnoses could be made at baseline (97 (54%) vs 46 (26%); p< 0.001). In the group with at least 5 years of follow-up, 33% of patients who were diagnosed with MS using the 2017 criteria did not experience a second attack during follow-up versus 23% when using the 2010 criteria.
Conclusion: The 2017 revised McDonald criteria are more sensitive but less specific for a second attack than the previous 2010 criteria. The trade-off is that it leads to a higher number of MS diagnoses in patients with a less active disease course.
Disclosure: Roos M. van der Vuurst de Vries: nothing to disclose, Julia Y. Mescheriakova: nothing to disclose, Yu Yi M. Wong: nothing to disclose, Tessel F. Runia: nothing to disclose, Naghmeh Jafari: Received honoraria for serving on advisory boards for Teva, Merck, Roche and Sanofi Genzyme, Johnny P. Samijn: received honoraria for serving on advisory boards for Merck, Sanofi Genzyme and Roche. And received travel grants from Merck. He participated in trials with BiogenIdec, Merck, Roche and Sanofi Genzyme, outside the submitted work, Janet de Beukelaar: nothing to disclose, Beatrijs H.A. Wokke: nothing to disclose, Theodora A.M. Siepman: nothing to disclose, Rogier Q. Hintzen: received honoraria for serving on advisory boards for Biogen Idec, Roche, Sanofi. He participated in trials with BiogenIdec, Merck, Roche, Sanofi Genzyme and Novartis, outside the submitted work
Abstract: 140
Type: Free Communications
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Background and objective: Recently, the International Panel on Diagnosis of Multiple Sclerosis revised the McDonald 2010 criteria for the diagnosis of multiple sclerosis (MS). The new criteria are easier to apply and could lead to more and earlier diagnoses. It is important to validate these criteria globally for their accuracy in clinical practice.
Our aim was to evaluate the diagnostic accuracy of the McDonald 2017 criteria versus the 2010 criteria to predict clinically definite MS (CDMS) in patients with a typical clinically isolated syndrome (CIS).
Methods: We included 229 patients between March 2006 and August 2016 in this prospective CIS cohort. Patients underwent a baseline MRI scan within three months after onset of symptoms and, if clinically required, a lumbar puncture was performed. CDMS was used as the gold standard for MS diagnosis. Sensitivity, specificity, accuracy, positive and negative predictive value were calculated after 1, 3 and 5 years for the 2017 versus the 2010 criteria.
Results: Among the 229 CIS patients, 167 were female (73%). The mean (SD) age was 33.5 (8.2) years. Hundred and thirteen patients (49%) were diagnosed with CDMS during a mean (SD) follow-up time of 65.3 (30.9) months. Sensitivity for the 2017 criteria was higher than for the 2010 criteria (68% vs 36%; p< 0.001), but specificity was lower (61% vs 85%; p< 0.001). Using the 2017 criteria more MS diagnoses could be made at baseline (97 (54%) vs 46 (26%); p< 0.001). In the group with at least 5 years of follow-up, 33% of patients who were diagnosed with MS using the 2017 criteria did not experience a second attack during follow-up versus 23% when using the 2010 criteria.
Conclusion: The 2017 revised McDonald criteria are more sensitive but less specific for a second attack than the previous 2010 criteria. The trade-off is that it leads to a higher number of MS diagnoses in patients with a less active disease course.
Disclosure: Roos M. van der Vuurst de Vries: nothing to disclose, Julia Y. Mescheriakova: nothing to disclose, Yu Yi M. Wong: nothing to disclose, Tessel F. Runia: nothing to disclose, Naghmeh Jafari: Received honoraria for serving on advisory boards for Teva, Merck, Roche and Sanofi Genzyme, Johnny P. Samijn: received honoraria for serving on advisory boards for Merck, Sanofi Genzyme and Roche. And received travel grants from Merck. He participated in trials with BiogenIdec, Merck, Roche and Sanofi Genzyme, outside the submitted work, Janet de Beukelaar: nothing to disclose, Beatrijs H.A. Wokke: nothing to disclose, Theodora A.M. Siepman: nothing to disclose, Rogier Q. Hintzen: received honoraria for serving on advisory boards for Biogen Idec, Roche, Sanofi. He participated in trials with BiogenIdec, Merck, Roche, Sanofi Genzyme and Novartis, outside the submitted work