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• W2804662093 abstract "We thank Axel Petzold for highlighting the most substantial change in the 2017 McDonald criteria for multiple sclerosis compared with the 2010 criteria, namely that, in a patient with a typical clinically isolated syndrome and fulfillment of clinical or MRI criteria for dissemination in space, demonstration of CSF-specific oligoclonal bands now allows a diagnosis of multiple sclerosis to be made.1Thompson AJ Banwell BL Barkhof F et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2017; 17: 162-173Summary Full Text Full Text PDF PubMed Scopus (2979) Google Scholar As the case he describes illustrates, in the 2017 criteria, the presence of CSF-specific oligoclonal bands in the appropriate setting substitutes for the requirement to demonstrate dissemination in time, allowing disease therapy to be initiated if indicated. This, in fact, was the intent of the revision. He correctly points out important factors in the interpretation of CSF oligoclonal bands: appropriate specimen handling and analytical techniques, and analysis of paired CSF and serum samples to confirm that the oligoclonal bands are unique to CSF.2Freedman M Thompson EJ Deisenhammer F et al.Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement.Arch Neurol. 2005; 62: 865-870Crossref PubMed Scopus (439) Google Scholar A final important point that Petzold makes, and that Masoud Etemadifar and Fateme Sabeti also emphasise, is recognition that CSF oligoclonal bands are not specific for multiple sclerosis and can be used to support the diagnosis only when the overall CSF findings, other laboratory tests, and clinical features do not point to an alternative diagnosis.3Andersson M Alvarez-Cermeno J Bernardi G et al.Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report.J Neurology Neurosurg Psychiatry. 1994; 57: 897-902Crossref PubMed Scopus (596) Google Scholar, 4Stangel M Fredrikson S Meinl E Petzold A Stuve O Tumani H The utility of cerebrospinal fluid analysis in patients with multiple sclerois.Nat Rev Neurol. 2013; 9: 267-276Crossref PubMed Scopus (140) Google Scholar Paulus Rommer and Uwe Zettl advocate incorporating CSF oligoclonal bands formally into the McDonald criteria to demonstrate intrathecal antibody production and confirm an inflammatory disease process. The International Panel on Diagnosis of Multiple Sclerosis addressed this point in its discussions, but noted that CSF oligoclonal bands are neither complet ely specific nor sensitive for multiple sclerosis,4Stangel M Fredrikson S Meinl E Petzold A Stuve O Tumani H The utility of cerebrospinal fluid analysis in patients with multiple sclerois.Nat Rev Neurol. 2013; 9: 267-276Crossref PubMed Scopus (140) Google Scholar particularly early in the disease process when diagnostic uncertainty is most problematic. Thus, the Panel decided on not requiring specific findings on CSF examination to make the diagnosis in all cases. Nevertheless, as stated in our Position Paper,1Thompson AJ Banwell BL Barkhof F et al.Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2017; 17: 162-173Summary Full Text Full Text PDF PubMed Scopus (2979) Google Scholar clinicians should have a low threshold to undertake CSF analysis to increase diagnostic confidence when there is insufficient clinical and MRI evidence to support a diagnosis of multiple sclerosis; with a presentation other than a typical clinically isolated syndrome; with clinical, imaging, or laboratory features atypical of multiple sclerosis; and in populations in which multiple sclerosis is less common. We thank Philipp Schwenkenbecher and colleagues for presenting data supporting the improved sensitivity of the 2017 McDonald criteria compared with the 2005 and 2010 criteria. This work contributes to the validation of the Panel's recommendations. Elia Sechi and colleagues note that the 2017 McDonald criteria for patients with a progressive course from onset were not changed from the 2010 McDonald criteria, aside from including cortical brain MRI lesions in addition to juxtacortical lesions to make the diagnosis and that no distinction between symptomatic and asymptomatic MRI lesions is required. They indicate that with these changes some patients with so-called progressive solitary sclerosis5Keegan BM Kaufmann TJ Weinshenker BG et al.Progressive solitary sclerosis. Gradual motor impairment from a single CNS demyelinating lesion.Neurology. 2016; 87: 1713-1719Crossref PubMed Scopus (54) Google Scholar might meet the diagnostic criteria for primary progressive multiple sclerosis, specifically, patients with a progressive course over 1 year, a supratentorial or infratentorial brain lesion characteristic of multiple sclerosis, and CSF-specific oligoclonal bands. While this is correct, a similar patient who has a single symptomatic lesion in the cervical cord—ie, in an only slightly more caudal location—would not fulfill the criteria. The Panel noted this and other apparent inconsistencies in such special circumstances but, as indicated, we required that any revisions to the criteria be based on supporting data. Sechi and colleagues' point deserves fuller exploration. We look forward to new data to inform further refinement of the McDonald criteria, especially for patients with atypical presentations. AJT reports personal fees and other support from MedDay, Novartis, Eisai Ltd, Biogen Idec, TEVA, and Hoffman-La Roche outside the submitted work; Editorial Board membership of The Lancet Neurology; being Editor-in-Chief of Multiple Sclerosis Journal, for which he receives an honorarium from SAGE Publications; being Chair, Scientific Advisory Board of the International Progressive MS Alliance (PMSA), for which he receives support for travel to international meetings; being a member of the National MS Society (USA) Research Programs Advisory Committee, for which he receives support for travel to international meetings; being Chair, International Medical and Scientific Board, and Board Member (2005-2015), for Multiple Sclerosis International Federation (MSIF), for which he receives support for travel to international meetings; and being a member of MSIF International Medical and Scientific Board (since 2015). He has received honoraria and support for travel for lecturing from EXCEMED, and has received support from the University College London Hospitals National Institute for Health Research Biomedical Research Centre. SCR reports: personal fees and other support from the National Multiple Sclerosis Society and the European Committee for Treatment and Research in Multiple Sclerosis; personal fees and other support from F Hoffmann-LaRoche, Ionis Pharmaceuticals, MedDay Pharmaceuticals SA, MedImmune, Merck Serono, and Novartis; other support from the Observatoire Français pour la Sclérose en Plaques; personal fees from Opexa Therapeutics, Teva Pharmaceuticals Industries, and TG Therapeutics; and personal fees and non-financial support from Scientific and Clinical Review Associates. JAC reports personal fees from Adamas and Celgene outside the submitted work, and has served as a co-editor of Multiple Sclerosis Journal—Experimental, Translational and Clinical. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteriaThe 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. Full-Text PDF Applying the 2017 McDonald diagnostic criteria for multiple sclerosisIn the 2017 revisions of the McDonald criteria, the International Panel on Diagnosis of Multiple Sclerosis decided that, if dissemination in space is fulfilled and multiple sclerosis is the best explanation for a patient's clinical manifestations, CSF-specific oligoclonal bands can substitute for the requirements for fulfilling dissemination in time.1 Full-Text PDF Applying the 2017 McDonald diagnostic criteria for multiple sclerosisThe recent Position Paper by Alan Thompson and colleagues reviewed the 2010 McDonald criteria and recommended revisions to allow for the more rapid diagnosis of multiple sclerosis.1 Increased diagnostic sensitivity is expected to be achieved by extension of the criteria of dissemination in space and time. In addition to juxtacortical lesions, cortical lesions can now be used to fulfil MRI criteria for dissemination in space. Furthermore, both symptomatic and asymptomatic MRI lesions can be considered in the determination of dissemination in space or time. Full-Text PDF Applying the 2017 McDonald diagnostic criteria for multiple sclerosisThe 2017 revisions to the McDonald criteria were recently presented by the International Panel on Diagnosis of Multiple Sclerosis.1 One major change from the 2010 McDonald criteria2 is the inclusion of symptomatic lesions in the total number of demyelinating lesions. With this revision, a diagnosis of primary progressive multiple sclerosis can now be made with a single symptomatic, infratentorial, periventricular, cortical, or juxtacortical lesion with at least 1 year of disease progression and evidence of CSF oligoclonal bands. Full-Text PDF Applying the 2017 McDonald diagnostic criteria for multiple sclerosisThe 2017 McDonald criteria recommend that intrathecal IgG synthesis (ie, oligoclonal bands) be considered in the diagnosis of multiple sclerosis.1 However, the practical implications of this recommendation depend on analytical accuracy of the test for oligoclonal bands and the clinical interpretation of the test results. Full-Text PDF Applying the 2017 McDonald diagnostic criteria for multiple sclerosisThe aims of the 2017 revision of the McDonald criteria for multiple sclerosis are earlier diagnosis and less frequent misdiagnosis.1 We do believe that the 2017 criteria will speed up the diagnostic process. Nevertheless, we do not believe that the revised criteria will substantially reduce misdiagnosis. Revisions of the diagnostic criteria for MS have led to earlier2 and more frequent diagnoses of multiple sclerosis but this might be accompanied by more false-positive diagnoses.3 Full-Text PDF" @default.
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• W2804662093 title "Applying the 2017 McDonald diagnostic criteria for multiple sclerosis – Authors' reply" @default.
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