New Criteria for Earlier MS Diagnosis
An international panel of neurologists who are leading experts in Multiple Sclerosis approved new revisions to the standard diagnostic criteria for MS, with the goal of diagnosing the disease earlier in patients while also reducing the risk of misdiagnosis. Their revisions applied to the 2010 McDonald criteria, which features the standard diagnostic guidelines that are currently utilized by doctors to help facilitate diagnosis of the condition. A primary aim of these changes is to allow doctors to better diagnose patients who are likely to have the disease but have been unable to be diagnosed in the past due to the limitations of the McDonald criteria (Remaly, 2017).
Diagnostic Revisions to the McDonald Criteria
Multiple revisions have been made to the McDonald criteria for faster and more reliable diagnosis of MS in individuals. Dr. Jeffrey A. Cohen, MD, and Alan J. Thompson, MD, cochaired the International Panel on Diagnosis of MD and drafted these new recommendations that led to the changes. One of these changes stipulates that in some cases, the presence of oligoclonal bands in the cerebrospinal fluid in a person with a clinically isolated syndrome (CIS) can substitute for demonstration of dissemination of lesions in time. Another major change to these criteria is that symptomatic and asymptomatic MRI lesions are now factors in the determination of dissemination in space or time. A third key change to the McDonald criteria regards the site of lesions. In addition to the presence of juxtacortical lesions, cortical lesions can now be considered for determining MRI criteria for dissemination of lesions in space. Moreover, the panel advised that an MRI of the brain should be acquired during the diagnostic procedure of MS. If further data are required to confirm a diagnosis, then a spinal MRI should be procured (National Multiple Sclerosis Society, 2017).
These new changes to the McDonald criteria are part of an expanding effort by neurologists to diagnose MS earlier in patients, while also reducing the occurrence of misdiagnosis. Doctors have already been making earlier diagnoses in recent years, thanks to advances in imaging, laboratory testing, and more. However, these new revisions to the standard diagnostic guidelines could allow this to occur several years sooner in some patients, so that treatment effectiveness can improve and irreversible damages to the central nervous system are better contained and limited.
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National Multiple Sclerosis Society. (2017). Updated McDonald Criteria Expected to Speed the Diagnosis of MS and Reduce Misdiagnosis. (2017, December 21). Retrieved March 31, 2018, from https://www.nationalmssociety.org/About-the-Society/News/Updated-McDonald-Criteria-Expected-to-Speed-the-Di
Remaly, J. (2017). Revised McDonald Criteria Allow Substitution for Dissemination in Time. Neurology Reviews,25(12), 37. Retrieved March 22, 2018, from https://www.mdedge.com/neurologyreviews/article/153112/multiple-sclerosis/revised-mcdonald-criteria-allow-substitution