Dr. Jerry Cohen, Mellen Center, Cleveland Clinic, gave the Presidential Lecture for the Consortium of MS Centers Annual Meeting, addressing the revised McDonald Diagnosis Criteria for multiple sclerosis. He began by telling his audience that he was unable to share the recommendations that will be coming out later this year from an international panel of experts because they have not quite finalized the revisions. The International Panel on Diagnosis of Multiple Sclerosis was funded by the National MS Society and the European Committee for Research and Treatment in MS (ECTRIMS), and Dr. Cohen is the panel co-chair revising the McDonald criteria.
What are the McDonald Criteria?
The McDonald Criteria was developed adopted in 2001 to assist neurologists with diagnosing MS and includes guidelines for MRI evidence, clinical exams and the use of spinal fluid. The current version in use is the 2010 McDonald Criteria. Dr Cohen said misdiagnosis with MS is quite common and the new criteria will help clinicians to be more accurate in their diagnosis.
Initial meetings of a panel of international neurologists were held in 2016 to begin the revision and they met again recently in Berlin, Germany. Dr. Cohen said he anticipates the latest version will be ready later this summer, but for now he is restricted as to what he could say in a public meeting.
Although Dr. Cohen was not able to talk to the specifics, he did share the points under consideration include revised phenotypes of MS, an expanded role of using cerebral spinal fluid (CSF) and how to incorporate methods of verifying optic neuritis where appropriate.
Misdiagnosis and MS
His talk focused on the percentage of people misdiagnosed with MS because of the continuing lack of absolute criteria, and expressed concern about the consequences of misdiagnosis. In recent studies looking at mis-diagnosis, the concern is this group is often prescribed disease modifying therapies for MS which they don’t need, their correct diagnosis is being overlooked, and MS can also have social, emotional and financial impact. All of these are viewed as negative effects of misdiagnosis.
In a separate briefing, Patricia Coyle, MD, Stony Brook University Medical Center, also talked about these revisions, saying they are based on new literature that addresses misdiagnosis and evidence based criteria that gives MS experts the opportunity to further refine the McDonald criteria. “With every revision, the diagnostic criteria becomes more helpful. And by following the formal criteria, it helps with the diagnosis rate,” said Dr. Coyle.
For those of us already diagnosed and are confident that it is correct, this new criteria will have no impact. For people who exhibit signs of MS but are not yet formally diagnosed, the hope is this new criteria will lead to greater certainty in a diagnosis of multiple sclerosis.
Wishing you well,