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The 2024 McDonald criteria show comparable sensitivity to previous criteria for late-onset multiple sclerosis
Raquel Tena-Cucala1, Pablo Naval-Baudin2, Antonio Martínez-Yélamos3
1Department of Neurology, Hospital de Tortosa Verge de la Cinta, Institut Català de la Salut, Tortosa, Spain; Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus/Tarragona, Spain; Departament de Ciències Clíniques, Facultat de Medicina I Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036, Barcelona, Spain.
Background:
The 2024 revision of the McDonald criteria introduces specific recommendations for diagnosing late-onset multiple sclerosis (LOMS). One of the following criteria must be met: spinal cord lesions, positive cerebrospinal fluid (CSF) findings, or fulfilment of the Select-6 criteria (i.e., six or more central vein signs on brain magnetic resonance imaging (MRI)).
Objectives:
To evaluate the sensitivity of the 2024 McDonald criteria in patients with LOMS and to identify the most sensitive diagnostic test.
Methods:
This cross-sectional, observational, retrospective study included patients diagnosed with LOMS (onset ≥50 years of age) who were followed at the Multiple Sclerosis Clinic of Bellvitge University Hospital. Clinical records, MRI scans, and CSF analyses were reviewed to assess the presence of spinal cord lesions, central vein signs and oligoclonal bands (OCBs). The sensitivity of the 2024 recommended LOMS criteria was analysed.
Results:
115 patients met at least one of the proposed 2024 LOMS diagnostic criteria, resulting in a sensitivity of 100 %. Of these, 10.4 % fulfilled all three criteria, 52.1 % met two criteria (most commonly OCBs and spinal lesions). The remaining 37.4 % met only one: 53.5 % had spinal lesions, 46.5 % were positive for OCBs, and none met only the Select-6 criterion. The difference between the proportions meeting the OCB and spinal cord lesion criteria was not statistically significant (p = 0.581), but both were significantly more common than meeting the Select-6 criterion (p < 0.001).
Conclusions:
The 2024 McDonald criteria maintain high sensitivity for diagnosing LOMS. CSF analysis and spinal MRI are the most valuable tools, whereas the Select-6 criteria exhibited a lower diagnostic value.
