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An update on diagnosis of MS and
implications for treatment
Learning objectives
This module is intended to help you:
- Understand the 2017 revisions of the McDonald criteria
- Identify in which patients the criteria should be used
- Define what is needed to fulfil dissemination in space and time of lesion in the central nervous system (CNS)
- Appreciate how the revisions may impact people with clinically isolated syndrome (CIS)
Case study of a patient presenting with blurred vision
Francesca
- Age: 27 years
- Sex: Female
- Occupation: Office Manager
Medical history
- No significant medical event had occurred previously
Symptoms
- 1 week of blurred vision in the left eye with pain during ocular movements
Test results
- - Multiple brain and spinal cord MRI lesions
- - None of these lesions presented enhancement
- - Other CNS diseases were excluded
- - CSF-specific oligoclonal bands detected
CSF, cerebrospinal fluid; CNS, central nervous system; MRI, magnetic resonance imaging; MS, multiple sclerosis
Patient case derived from Mantero V, et al. J Clin Neurol. 2018.1
Patient case derived from Mantero V, et al. J Clin Neurol. 2018.1
Can a diagnosis of MS be made for Francesca, based on the 2017 McDonald criteria?
MRI, magnetic resonance imaging; MS, multiple sclerosis
Case study of a patient presenting with neurological symptoms
Stephanie
- Age: 23 years
- Sex: Female
- Occupation: Student
Medical history
- No medical history
Symptoms
- Reduced touch sensation on her left side and tingling in her hands, which lasted about 1 week
Test results
- - Brain and spinal cord MRI lesions, the spinal MRI showing two enhancing lesions – considered symptomatic
- - Other CNS diseases were excluded
- - CSF-specific oligoclonal bands detected
CSF, cerebrospinal fluid; CNS, central nervous system; MRI, magnetic resonance imaging
Patient case derived from Mantero V, et al. J Clin Neurol. 2018.1
Patient case derived from Mantero V, et al. J Clin Neurol. 2018.1
Can a diagnosis of MS be made for Stephanie, based on the 2017 McDonald criteria?
MRI, magnetic resonance imaging
- Mantero V, et al. J Clin Neurol. 2018;14:387–92.
- Thompson AJ, et al. Lancet Neurol. 2018;17:162–73.
- Straight Healthcare. Multiple sclerosis (MS). 2019. More info. Accessed November 2019.
- Gaitán MI, et al. Front Neurol. 2019;10:466.
- Deisenhammer F, et al. Front Immunol. 2019;10:726.
- Zipp F, et al. Nat Rev Neurol. 2019;15:441–5.
- Filippi M, et al. Curr Opin Neurol. 2018; 31: 386–95.
- Garrett B, et al. CMAJ 2016;188:E199.
- Filippi M, et al. Lancet Neurol. 2016;15:292–303.
- Filippi M, et al. Mult Scler. 2013;19:418–26.
- MS progression types. Physiopedia. 2014. More info. Accessed November 2019.
- Papadopoulos MC, et al. Nat Rev Neurol. 2014;10:493–506.
- Tenembaum S, et al. Neurology 2015;84:P5.275.
- Gassama S, et al. In: ECTRIMS Online Library. ECTRIMS, 2018: P339.
- Tintore M, et al. Neurology 2016;87:1368–74.
- Chalmer TA, et al. Eur J Neurol. 2018;25:1262-e110.
- Iaffaldano P, et al. In: ECTRIMS Online Library. ECTRIMS, 2018: 231469.
- Kamm CP, et al. J Neurol 2020;267:153–61.
- Burke T, et al. Int J MS Care 2011;13:105–12.
- Schwenkenbecher P, et al. Front Neurol. 2019;10:188.
- Giovannoni G. Mult Scler J. 2018;24:328–529.
- Mattarozzi K, et al. Int J Clin Pract. 2012;66:504–14.
In your centre, are people who were diagnosed with CIS before 2017 being re-evaluated following the 2017 McDonald criteria revisions?
In a patient with CIS, which of the following can now substitute for dissemination in time and allow confirmation of a diagnosis of MS
AQP-4, aquaporin-4; CIS, clinically isolated syndrome; CSF, cerebrospinal fluid; JCV, John Cunningham virus
- Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17: 162–73.
A patient is visiting a clinic for their first diagnostic consultation, what duration of consultation has been shown to be the optimal length for patient satisfaction?
A study found that good satisfaction with the first diagnostic consultation was associated with a conversation of more than 20 minutes.
- Kamm CP, Barin L, Gobbi C, et al. Factors influencing patient satisfaction with the first diagnostic consultation in multiple sclerosis: a Swiss Multiple Sclerosis Registry (SMSR) study. J Neurol. 2020; 267: 153–61.
When the 2017 diagnostic criteria are applied to patients previously diagnosed with CIS, what generally happens to the proportion of patients who can be diagnosed with MS and CIS?
Among 1,321 patients with a clinical event suggestive of MS, 37% received an MS diagnosis when the 2010 McDonald criteria was applied but application of the 2017 McDonald criteria on the same cohort allowed the diagnosis of 68% of the patients
CIS, clinically isolated syndrome
- Schwenkenbecher P, Wurster U, Konen FF, et al. Impact of the McDonald Criteria 2017 on Early Diagnosis of Relapsing–Remitting Multiple Sclerosis. Front Neurol. 2019; 10: 188.
According to a study by Kamm et al. which factors increased patients’ satisfaction in the first diagnostic consultation?
Select all that apply
A recent study found that factors that enhanced patients’ satisfaction in the first diagnostic consultation included a conversation of more than twenty minutes, a clear communication of the diagnosis, the presence of a close relative or significant other, as well as shared decision-making
min, minute
- Kamm CP, Barin L, Gobbi C, et al. Factors influencing patient satisfaction with the first diagnostic consultation in multiple sclerosis: a Swiss Multiple Sclerosis Registry (SMSR) study. J Neurol. 2020; 267: 153–61.
Congratulations!
You have completed module 2
Links and downloadable elements
An update on diagnosis of MS and implications for treatment
The diagnostic criteria for MS recently changed. This module outlines how to apply the criteria revisions in clinical practice and the potential impact on people currently diagnosed with clinically isolated syndrome.
Length
14 min course
Job code
HQ/MS/19/0040
