Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria - 14/03/18

Doi : 10.1016/S1474-4422(17)30470-2

Alan J Thompson, ProfMD ^a, Brenda L Banwell, ProfMD ^e, Frederik Barkhof, ProfMD ^b,^d,^f, William M Carroll, ProfMD ^g, Timothy Coetzee, PhD ^h, Giancarlo Comi, ProfMD ⁱ, Jorge Correale, ProfMD ^k, Franz Fazekas, ProfMD ^l, Massimo Filippi, ProfMD ^j, Mark S Freedman, ProfMD ^m, Kazuo Fujihara, ProfMD ^n,^o, Steven L Galetta, ProfMD ^p, Hans Peter Hartung, ProfMD ^q, Ludwig Kappos, ProfMD ^r, Fred D Lublin, ProfMD ^s, Ruth Ann Marrie, ProfMD ^t, Aaron E Miller, ProfMD ^s, David H Miller, ProfMD ^c, Xavier Montalban, ProfMD ^u,^v, Ellen M Mowry, MD ^w, Per Soelberg Sorensen, ProfMD ^x, Mar Tintoré, MD ^u, Anthony L Traboulsee, MD ^y, Maria Trojano, ProfMD ^z, Bernard M J Uitdehaag, ProfMD ^aa, Sandra Vukusic, ProfMD ^ab,^ac,^ad, Emmanuelle Waubant, ProfMD ^ae, Brian G Weinshenker, ProfMD ^af, Stephen C Reingold, PhD ^ag, Jeffrey A Cohen, ProfMD ^ah,^⁎

^a Faculty of Brain Sciences, University College London, London, UK

^b Institute of Healthcare Engineering, University College London, London, UK

^c Queen Square Multiple Sclerosis Centre, University College London, London, UK

^d Institute of Neurology, University College London, London, UK

^e Division of Neurology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

^f Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands

^g Neurology Department, Sir Charles Gairdner Hospital, Perth, WA, Australia

^h National Multiple Sclerosis Society, New York, NY, USA

ⁱ Department of Neurology, Vita-Salute San Raffaele University-Ospedale San Raffaele, Milan, Italy

^j The Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University-Ospedale San Raffaele, Milan, Italy

^k Institute for Neurological Research Dr. Raúl Carrea, FLENI, Buenos Aires, Argentina

^l Department of Neurology, Medical University of Graz, Graz, Austria

^m Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

ⁿ Department of Multiple Sclerosis Therapeutics, School of Medicine, Fukushima Medical University, Fukushima, Japan

^o Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima, Japan

^p Department of Neurology, New York University Langone Medical Center, New York, NY, USA

^q Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany

^r Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland

^s Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA

^t Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

^u Centre d’Esclerosi Múltiple de Catalunya, Vall d’Hebron University Hospital, Barcelona, Spain

^v Division of Neurology, University of Toronto, St Michael’s Hospital, Toronto, ON, Canada

^w Department of Neurology, Johns Hopkins University, Baltimore, MD, USA

^x Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark

^y Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

^z Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy

^aa Department of Neurology, VU University Medical Center, Amsterdam, Netherlands

^ab Service de neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France

^ac Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Lyon, France

^ad Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Est, Villeurbanne, Auvergne-Rhône-Alpes, France

^ae Department of Neurology, University of California at San Francisco, San Francisco, CA, USA

^af Department of Neurology, Mayo Clinic, Rochester, MN, USA

^ag Scientific and Clinical Review Associates LLC, Salisbury, CT, USA

^ah Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA

^* Correspondence to: Prof Jeffrey A Cohen, Neurologic Institute, Cleveland Clinic, Cleveland, OH 44195, USA Correspondence to: Prof Jeffrey A Cohen, Neurologic Institute Cleveland Clinic Cleveland OH 44195 USA

Summary

The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.

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Plan

Introduction

Rationale and methods for the 2017 revisions

Usefulness and applicability of the 2010 McDonald criteria

Misdiagnosis and differential diagnosis

Applicability of the 2010 McDonald criteria in diverse populations

Neuromyelitis optica spectrum disorders

Role of MRI in diagnosis of multiple sclerosis

Role of CSF examination in diagnosis of multiple sclerosis

2017 revisions to the McDonald criteria

CSF oligoclonal bands

Symptomatic lesions as evidence for dissemination in space and time

Cortical lesions equivalent to juxtacortical lesions

Application in multiple sclerosis subtypes

Key proposals that require further evidence

Number of periventricular lesions

Incorporation of the anterior visual system into the criteria

Applicability of the McDonald criteria in patients with atypical presentations

Other high-priority areas for research

Conclusions

Search strategy and selection criteria

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Vol 17 - N° 2

P. 162-173 - février 2018 Retour au numéro

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Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria - 14/03/18

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