Wallace J Brownlee1, Katherine A Miszkiel2, Carmen Tur2, Frederik Barkhof2, David H Miller2, Olga Ciccarelli2. 1. From the Queen Square Multiple Sclerosis Centre (W.J.B., C.T., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology; Lysholm Department of Neuroradiology (K.A.M., F.B.), National Hospital for Neurology and Neurosurgery; UCL Institute of Healthcare Engineering (F.B.), London, UK; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; and NIHR University College London Hospitals Biomedical Research Centre (F.B., O.C.), UK. w.brownlee@ucl.ac.uk. 2. From the Queen Square Multiple Sclerosis Centre (W.J.B., C.T., D.H.M., O.C.), Department of Neuroinflammation, UCL Institute of Neurology; Lysholm Department of Neuroradiology (K.A.M., F.B.), National Hospital for Neurology and Neurosurgery; UCL Institute of Healthcare Engineering (F.B.), London, UK; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; and NIHR University College London Hospitals Biomedical Research Centre (F.B., O.C.), UK.
Abstract
OBJECTIVE: To investigate the effect of including optic nerve involvement in dissemination in space (DIS) criteria for diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS). METHODS: We studied 160 patients with CIS: 129 with optic neuritis (ON) and 31 with non-ON CIS. MRI brain/spinal cord was done at the time of presentation and a follow-up MRI brain after 3-12 months. We evaluated optic nerve involvement clinically or with visual evoked potentials (VEPs, n = 42). We investigated the performance of the McDonald 2017 DIS criteria and modified DIS criteria including optic nerve involvement for development of clinically definite MS after ∼15 years. RESULTS: In the ON group, including symptomatic optic nerve involvement identified an additional 15 patients with DIS. The modified DIS criteria that included optic nerve involvement were more sensitive (95% vs 83%) and more accurate (81% vs 78%) than the McDonald 2017 DIS criteria, but less specific (57% vs 68%). In combination with dissemination in time criteria, the modified DIS criteria remained more sensitive (83% vs 74%) and accurate (81% vs 75%), and the specificity was the same (77%). Including asymptomatic optic nerve involvement in DIS the non-ON group did not identify any additional patients and the performance of the McDonald 2017 criteria and the modified criteria was the same. CONCLUSION: The inclusion of symptomatic optic nerve involvement in DIS in patients with ON improved the overall performance of MS diagnostic criteria. Including asymptomatic optic nerve involvement in DIS in patients with a non-ON CIS may be of limited value. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with suspected MS, inclusion of symptomatic optic nerve involvement in DIS criteria improves the overall performance of diagnostic criteria for MS.
OBJECTIVE: To investigate the effect of including optic nerve involvement in dissemination in space (DIS) criteria for diagnosis of multiple sclerosis (MS) in patients with clinically isolated syndrome (CIS). METHODS: We studied 160 patients with CIS: 129 with optic neuritis (ON) and 31 with non-ON CIS. MRI brain/spinal cord was done at the time of presentation and a follow-up MRI brain after 3-12 months. We evaluated optic nerve involvement clinically or with visual evoked potentials (VEPs, n = 42). We investigated the performance of the McDonald 2017 DIS criteria and modified DIS criteria including optic nerve involvement for development of clinically definite MS after ∼15 years. RESULTS: In the ON group, including symptomatic optic nerve involvement identified an additional 15 patients with DIS. The modified DIS criteria that included optic nerve involvement were more sensitive (95% vs 83%) and more accurate (81% vs 78%) than the McDonald 2017 DIS criteria, but less specific (57% vs 68%). In combination with dissemination in time criteria, the modified DIS criteria remained more sensitive (83% vs 74%) and accurate (81% vs 75%), and the specificity was the same (77%). Including asymptomatic optic nerve involvement in DIS the non-ON group did not identify any additional patients and the performance of the McDonald 2017 criteria and the modified criteria was the same. CONCLUSION: The inclusion of symptomatic optic nerve involvement in DIS in patients with ON improved the overall performance of MS diagnostic criteria. Including asymptomatic optic nerve involvement in DIS in patients with a non-ON CIS may be of limited value. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with suspected MS, inclusion of symptomatic optic nerve involvement in DIS criteria improves the overall performance of diagnostic criteria for MS.
Authors: D H Miller; M R Newton; J C van der Poel; E P du Boulay; A M Halliday; B E Kendall; G Johnson; D G MacManus; I F Moseley; W I McDonald Journal: Neurology Date: 1988-02 Impact factor: 9.910
Authors: Massimo Filippi; Paolo Preziosa; Alessandro Meani; Olga Ciccarelli; Sarlota Mesaros; Alex Rovira; Jette Frederiksen; Christian Enzinger; Frederik Barkhof; Claudio Gasperini; Wallace Brownlee; Jelena Drulovic; Xavier Montalban; Stig P Cramer; Alexander Pichler; Marloes Hagens; Serena Ruggieri; Vittorio Martinelli; Katherine Miszkiel; Mar Tintorè; Giancarlo Comi; Iris Dekker; Bernard Uitdehaag; Irena Dujmovic-Basuroski; Maria A Rocca Journal: Lancet Neurol Date: 2017-12-21 Impact factor: 44.182
Authors: Alan J Thompson; Brenda L Banwell; Frederik Barkhof; William M Carroll; Timothy Coetzee; Giancarlo Comi; Jorge Correale; Franz Fazekas; Massimo Filippi; Mark S Freedman; Kazuo Fujihara; Steven L Galetta; Hans Peter Hartung; Ludwig Kappos; Fred D Lublin; Ruth Ann Marrie; Aaron E Miller; David H Miller; Xavier Montalban; Ellen M Mowry; Per Soelberg Sorensen; Mar Tintoré; Anthony L Traboulsee; Maria Trojano; Bernard M J Uitdehaag; Sandra Vukusic; Emmanuelle Waubant; Brian G Weinshenker; Stephen C Reingold; Jeffrey A Cohen Journal: Lancet Neurol Date: 2017-12-21 Impact factor: 44.182
Authors: Wallace J Brownlee; Josephine K Swanton; Katherine A Miszkiel; David H Miller; Olga Ciccarelli Journal: Neurology Date: 2016-07-15 Impact factor: 9.910
Authors: C M Poser; D W Paty; L Scheinberg; W I McDonald; F A Davis; G C Ebers; K P Johnson; W A Sibley; D H Silberberg; W W Tourtellotte Journal: Ann Neurol Date: 1983-03 Impact factor: 10.422
Authors: Wallace J Brownlee; Josephine K Swanton; Daniel R Altmann; Olga Ciccarelli; David H Miller Journal: J Neurol Neurosurg Psychiatry Date: 2014-11-20 Impact factor: 10.154
Authors: Massimo Filippi; Maria A Rocca; Olga Ciccarelli; Nicola De Stefano; Nikos Evangelou; Ludwig Kappos; Alex Rovira; Jaume Sastre-Garriga; Mar Tintorè; Jette L Frederiksen; Claudio Gasperini; Jacqueline Palace; Daniel S Reich; Brenda Banwell; Xavier Montalban; Frederik Barkhof Journal: Lancet Neurol Date: 2016-01-26 Impact factor: 44.182