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Multiple Sclerosis l: Introduction01:19

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

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Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study

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Optic nerve involvement is common in clinically isolated syndrome (CIS) and can be detected using MRI, OCT, or VEP. Adding the optic nerve to diagnostic criteria improves detection of dissemination in space (DIS) for multiple sclerosis (MS).

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Area of Science:

  • Neuroscience
  • Radiology
  • Ophthalmology

Background:

  • The optic nerve is not currently included in the 2017 McDonald criteria for diagnosing multiple sclerosis (MS) dissemination in space (DIS).
  • Early detection of CNS involvement is crucial for timely MS diagnosis and treatment.

Purpose of the Study:

  • To determine if optic nerve imaging (optic nerve-MRI, optical coherence tomography, visual evoked potentials) can detect optic nerve involvement in clinically isolated syndrome (CIS).
  • To evaluate the utility of incorporating optic nerve topography into the diagnostic criteria for MS.

Main Methods:

  • A prospective, multicenter study involving 157 patients with CIS who underwent visual assessments (ON-MRI, OCT, VEP).
  • Modified DIS criteria were developed by including optic nerve topography as a fifth CNS area.
  • Risk assessment and performance analysis compared modified DIS criteria against the 2017 McDonald criteria for MS diagnosis.

Main Results:

  • Optic nerve involvement was detected in 40.2% of CIS patients via ON-MRI, rising to 72.5% in those with optic neuritis.
  • At follow-up, 70.7% of patients were diagnosed with MS.
  • Modified DIS criteria demonstrated higher sensitivity (92.5% with ON-MRI) and comparable accuracy (86.6% with ON-MRI) to the 2017 DIS criteria.

Conclusions:

  • Optic nerve lesions are frequently identified in CIS patients, particularly those with optic neuritis, using MRI, OCT, or VEP.
  • Incorporating the optic nerve as a fifth area into DIS criteria enhances the diagnostic accuracy for MS.