“It is clear that with every rendition of the McDonald criteria the diagnosis of MS can be made sooner and requires less imaging. Although less imaging will be save the NHS money is it that important to make the diagnosis of MS sooner? It will mean that more CISers who will turn out have a benign course will be diagnosed with MS even though they may never have a another attack; this will change the prognosis of MS by making it more favourable. This is what we call the Will Rogers phenomenon, which I have discussed in the past.”
“Do you know who Will Rogers was? A very interesting and funny man I am told.”
“Will an earlier diagnosis of MS allow quicker access the DMTs? Yes, in principle. However, in the UK you need to have 2 clinical attacks in a 24 month period to access DMTs. So no not really. The situation in other countries will be different.”
“Will an earlier diagnosis of MS improve the emotional well-being of CISers? B told you have MS may be better than being told you are at risk of developing MS. There may be more anxiety associated with being in a state of limbo. I am not sure, a diagnosis of MS comes with its own can of worms; one of worm being anxiety. Interestingly, the life insurance industry treats CIS and MS as the same entity.”
“In my opinion, the McDonald criteria doesn’t quite get to the heart of MS. MS is a biological disease and we need to be able to diagnosis it before you develop the disease so that we can prevent or at least optimise early treatment. If we want to make a really big difference to the outcome of this disease we need to get to the disease process ASAP. It has already been shown, many times, that once people have established disease and have acquired disability the horse has bolted; i.e. it is impossible to regain what is lost. So the sooner we make the diagnosis and switch off the shredder the better. At least 30-40% of CISers already have significant cognitive impairment. Therefore, I imagine not too far in the distant future the McDonald criteria including asymptomatic MS as part of the classification.”
“I am sure some of you will disagree.”
Epub: Kang et al.Application and a proposed modification of the 2010 McDonald criteria for the diagnosis of multiple sclerosis in a Canadian cohort of patients with clinically isolated syndromes. Mult Scler. 2013 Aug 22.
BACKGROUND: The 2005 and 2010 McDonald criteria utilize magnetic resonance imaging (MRI) to provide evidence of disease dissemination in space (DIS) and time (DIT) for the diagnosis of multiple sclerosis (MS) in people who have clinically isolated syndromes (CIS).
METHODS: Data from 109 CISers not satisfying the 2005 criteria at entry into a randomized controlled minocycline trial were analyzed to determine the proportion who would have been diagnosed with MS at screening based on 2010 criteria. The impact of including symptomatic, as well as asymptomatic, MRI lesions to confirm DIT was also explored.
RESULTS: Thirty percent (33/109) of CISers, retrospectively, met the 2010 criteria for a diagnosis of MS at baseline. When both symptomatic and asymptomatic lesions were used to confirm DIT, three additional MSers met the 2010 criteria. There was a significant 10.1% increase in the proportion of CISers who met the 2010 DIS criteria, compared with the 2005 DIS criteria; however, two CISers satisfied the 2005 DIS but not 2010 DIS criteria.
CONCLUSION: Using 2010 McDonald criteria, 30% of the CISers could be diagnosed with MS using a single MRI scan. Inclusion of symptomatic lesions in the DIT criteria further increases this proportion to 33%.