van der Vuurst de Vries RM, et al. - Researchers sought to validate the new diagnostic criteria proposed in 2017 for multiple sclerosis (MS) in patients with a typical clinically isolated syndrome (CIS) by comparing the diagnostic accuracy of the 2017 criteria vs the 2010 criteria in prediction of clinically definite MS. The 2017 revised McDonald criteria displayed a higher sensitivity but a lower specificity for a second attack. These criteria lead to a higher number of MS diagnoses in patients with a less active disease course.

Methods

• Researchers included 251 patients at Erasmus MC, Rotterdam, the Netherlands, in collaboration with several regional hospitals.
• Early in the diagnostic process, 13 patients received another diagnosis and were excluded from the analyses, while 9 patients with CIS did not want to participate in the study.
• In this prospective CIS cohort, 229 patients were left who were included between March 2006 and August 2016.
• Within 3 months after onset of symptoms, patients underwent a baseline magnetic resonance imaging scan and, if clinically required, had a lumbar puncture.
• From December 2017 and January 2018, they performed data analysis.
• Calculation of sensitivity, specificity, accuracy, and positive and negative predictive value was performed after 1, 3, and 5 years for the 2017 vs the 2010 criteria.

Results

• Women comprised 73% (n=167) of the 229 patients with CIS; the mean (SD) age was 33.5 (8.2) years.
• CDMS was diagnosed in 113 (49%) patients during a mean (SD) follow-up time of 65.3 (30.9) months.
• The 2017 criteria had higher sensitivity (68%; 95% CI, 57%-77% vs 36%; 95% CI, 27%-47%; P < .001), but lower specificity compared to the 2010 criteria (61%; 95% CI, 50%-71% vs 85%; 95% CI, 76%-92%; P < .001).
• More MS diagnoses were made at baseline using the 2017 criteria (n = 97 [54%]; 95% CI, 47%-61% vs n = 46 [26%]; 95% CI, 20%-32%; P < .001).
• A second attack was not observed in 33% of patients who were diagnosed as having MS using the 2017 criteria during follow-up vs 23% when using the 2010 criteria, in the group with at least 5 years of follow-up.