TY - JOUR
T1 - Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria
T2 - A Longitudinal, Prospective, Multicenter Study
AU - Vidal-Jordana, Angela
AU - Rovira, Alex
AU - Calderon, Willem
AU - Arrambide, Georgina
AU - Castilló, Joaquín
AU - Moncho, Dulce
AU - Rahnama, Kimia
AU - Collorone, Sara
AU - Toosy, Ahmed T
AU - Ciccarelli, Olga
AU - Papadopoulou, Athina
AU - Cerdá-Fuertes, Nuria
AU - Lieb, Johanna M
AU - Ruggieri, Serena
AU - Tortorella, Carla
AU - Gasperini, Claudio
AU - Bisecco, Alvino
AU - Capuano, Rocco
AU - Gallo, Antonio
AU - De Barros, Andrea
AU - Salerno, Annalaura
AU - Auger, Cristina
AU - Sastre-Garriga, Jaume
AU - Tintore, Mar
AU - Montalban, Xavier
N1 - Publisher Copyright:
© American Academy of Neurology.
PY - 2024/1/9
Y1 - 2024/1/9
N2 - BACKGROUND AND OBJECTIVES: The optic nerve is not one of the areas of the CNS that can be used to demonstrate dissemination in space (DIS) within the 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS). Objectives were (1) to assess whether optic nerve-MRI (ON-MRI), optical coherence tomography (OCT), and visual evoked potentials (VEP) detect optic nerve involvement in clinically isolated syndrome (CIS) and (2) to evaluate the contribution of the optic nerve topography to the current diagnostic criteria in a prospective, multicenter cohort.METHODS: MAGNIMS centers were invited to provide prospective data on patients with CIS who underwent a visual assessment with at least 2 of 3 investigations (ON-MRI, OCT, or VEP) within 6 months of onset. Modified DIS criteria were constructed by adding the optic nerve topography, defined by each investigation separately and any combination of them, as the fifth area of the CNS. A risk assessment analysis and the performance of the different DIS criteria were analyzed using the diagnosis of MS according to the 2017 McDonald criteria as the primary outcome and new T2 lesions and/or a second relapse as the secondary outcome.RESULTS: We included 157 patients with CIS from 5 MAGNIMS centers; 60/157 (38.2%) patients presented with optic neuritis. Optic nerve involvement on ON-MRI was found in 40.2% patients at study entry and in 72.5% of those with optic neuritis.At follow-up (mean 27.9 months, SD 14.5), 111/157 patients (70.7%) were diagnosed with MS according to the 2017 McDonald criteria. Fulfilling either 2017 DIS or any modified DIS criteria conferred a similar high risk for reaching primary and secondary outcomes. The modified DIS criteria had higher sensitivity (92.5% [with ON-MRI] vs 88.2%), but slightly lower specificity (80.0% [with GCIPL IEA ≥4 μm] vs 82.2%), with overall similar accuracy (86.6% [with ON-MRI] vs 86.5%) than 2017 DIS criteria. Consistent results were found for secondary outcomes.DISCUSSION: In patients with CIS, the presence of an optic nerve lesion defined by MRI, OCT, or VEP is frequently detected, especially when presenting with optic neuritis. Our study supports the addition of the optic nerve as a fifth topography to fulfill DIS criteria.
AB - BACKGROUND AND OBJECTIVES: The optic nerve is not one of the areas of the CNS that can be used to demonstrate dissemination in space (DIS) within the 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS). Objectives were (1) to assess whether optic nerve-MRI (ON-MRI), optical coherence tomography (OCT), and visual evoked potentials (VEP) detect optic nerve involvement in clinically isolated syndrome (CIS) and (2) to evaluate the contribution of the optic nerve topography to the current diagnostic criteria in a prospective, multicenter cohort.METHODS: MAGNIMS centers were invited to provide prospective data on patients with CIS who underwent a visual assessment with at least 2 of 3 investigations (ON-MRI, OCT, or VEP) within 6 months of onset. Modified DIS criteria were constructed by adding the optic nerve topography, defined by each investigation separately and any combination of them, as the fifth area of the CNS. A risk assessment analysis and the performance of the different DIS criteria were analyzed using the diagnosis of MS according to the 2017 McDonald criteria as the primary outcome and new T2 lesions and/or a second relapse as the secondary outcome.RESULTS: We included 157 patients with CIS from 5 MAGNIMS centers; 60/157 (38.2%) patients presented with optic neuritis. Optic nerve involvement on ON-MRI was found in 40.2% patients at study entry and in 72.5% of those with optic neuritis.At follow-up (mean 27.9 months, SD 14.5), 111/157 patients (70.7%) were diagnosed with MS according to the 2017 McDonald criteria. Fulfilling either 2017 DIS or any modified DIS criteria conferred a similar high risk for reaching primary and secondary outcomes. The modified DIS criteria had higher sensitivity (92.5% [with ON-MRI] vs 88.2%), but slightly lower specificity (80.0% [with GCIPL IEA ≥4 μm] vs 82.2%), with overall similar accuracy (86.6% [with ON-MRI] vs 86.5%) than 2017 DIS criteria. Consistent results were found for secondary outcomes.DISCUSSION: In patients with CIS, the presence of an optic nerve lesion defined by MRI, OCT, or VEP is frequently detected, especially when presenting with optic neuritis. Our study supports the addition of the optic nerve as a fifth topography to fulfill DIS criteria.
KW - Humans
KW - Multiple Sclerosis/diagnosis
KW - Evoked Potentials, Visual
KW - Prospective Studies
KW - Optic Nerve/diagnostic imaging
KW - Demyelinating Diseases
KW - Optic Neuritis/diagnostic imaging
KW - Humans
KW - Multiple Sclerosis/diagnosis
KW - Evoked Potentials, Visual
KW - Prospective Studies
KW - Optic Nerve/diagnostic imaging
KW - Demyelinating Diseases
KW - Optic Neuritis/diagnostic imaging
KW - Humans
KW - Multiple Sclerosis/diagnosis
KW - Evoked Potentials, Visual
KW - Prospective Studies
KW - Optic Nerve/diagnostic imaging
KW - Demyelinating Diseases
KW - Optic Neuritis/diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85180559317&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/833e904c-81e8-308e-b9f6-b7c677cd9b08/
U2 - 10.1212/wnl.0000000000207805
DO - 10.1212/wnl.0000000000207805
M3 - Article
C2 - 38165378
SN - 0028-3878
VL - 102
SP - e200805
JO - Neurology
JF - Neurology
IS - 1
M1 - e207805
ER -