After their publication, several studies compared the performance of the 2017 and 2010 revisions of the McDonald criteria in clinically isolated syndrome (CIS) patients (1). They showed that the 2017 criteria have higher sensitivity but lower speciﬁcity compared with the 2010 criteria in predicting clinically deﬁnite (CD) multiple sclerosis (MS), but a shorter time to MS diagnosis. However, several aspects were not fully explored. By evaluating a large multicenter cohort of patients with typical CIS, Filippi et al. (2) compared the performance of the 2017 criteria in predicting CDMS and MS prognosis, and in enabling an earlier MS diagnosis, with that of the 2010 criteria. The inﬂuence of type of CIS onset and the number of periventricular lesions needed to demonstrate dissemination in space (DIS) were also evaluated. The Authors reported that, at 36 months, the 2017 DIS plus dissemination in time criteria had higher sensitivity (0.83 vs 0.66), lower specificity (0.39 vs 0.60), and similar area under the curve values (0.61 vs 0.63) compared to 2010 revision. Median time to MS diagnosis was shorter with the 2017 vs the 2010 criteria, independently from the type of onset, and the 2 sets of criteria similarly predicted EDSS ≥3.0. Finally, they showed that three periventricular lesions improved specificity in patients ≥45 years.
This study suggests that the 2017 criteria have higher sensitivity, lower specificity, and similar accuracy in predicting CDMS compared to the 2010 criteria, while shortening time to diagnosis of MS. Three periventricular lesions improve specificity in patients ≥45 years.
- 2017 McDonald criteria have higher sensitivity, lower speciﬁcity, and overall similar accuracy compared with the 2010 McDonald criteria in predicting clinically definite multiple sclerosis (MS) development independently from the type of clinical onset.
- Median time to MS diagnosis was shorter with the 2017 vs the 2010 criteria.
- The 2 sets of criteria similarly predicted EDSS ≥3.0.
- Three periventricular lesions improved specificity in patients ≥45 years and should be considered in future revisions of the McDonald criteria to improve speciﬁcity and accuracy in older patients with clinically isolated syndrome.
- Schwenkenbecher P, Wurster U, Konen FF et al. Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing-Remitting Multiple Sclerosis. Frontiers in Neurology 2019; 10:188. doi: 10.3389/fneur.2019.00188 https://pubmed.ncbi.nlm.nih.gov/30930829/
- Filippi M, Preziosa P, Meani A et al. Performance of the 2017 and 2010 Revised McDonald Criteria in Predicting MS Diagnosis After a Clinically Isolated Syndrome. A MAGNIMS Study. Neurology 2022; 98:e1-e14. doi:10.1212/WNL.0000000000013016. https://pubmed.ncbi.nlm.nih.gov/34716250/