Commentary
Video
2024 Revisions to McDonald Diagnostic Criteria for Multiple Sclerosis: Peter Calabresi, MD
Author(s):
The codirector of the Precision Medicine MS Center at Johns Hopkins University discussed the new updates to the MS diagnostic criteria presented at the 40th ECTRIMS Congress in Copenhagen. [WATCH TIME: 5 minutes]
[WATCH TIME: 5 minutes]
“The imaging technology has really improved specificity and will help quite a lot. You have the 6 central vein sign lesions, and there are now publications showing how that adds specificity to the diagnosis of MS—there are some rarer exceptions that you have to think about, but I think it will help with misdiagnosis in addition to earlier diagnosis.”
The McDonald criteria for the diagnosis of multiple sclerosis (MS) have been revised for the third time in 15 years, in what is arguably the largest update since the introduction of the criteria in the early 2000s. These guidelines provide the basis for neurologists and MS specialists to differentiate MS from other demyelinating disorders, and these latest changes, presented by a group of experts at the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 18-20 in Copenhagen, Denmark, offer these clinicians the ability to potentially diagnose the disease—and potentially then initiate treatment for it—much earlier than before.
These revisions include the incorporation of new MRI technology and biomarkers, such as neurofilament light chain and the central vein sign, as well as further updates to the evaluation of changes to the optic nerve and information for identifying radiologically isolated syndrome (RIS). The session in which these updates were covered was chaired, in part, by Peter Calabresi, MD, the codirector of the Precision Medicine MS Center at Johns Hopkins University, and shortly after the session ended, he caught up with NeurologyLive® to discuss how these updates might impact clinical practice.
Notably, these 2024 revisions are not only complicated, but still awaiting peer-reviewed publication, so there is potential for changes to come. That in mind, they do offer a real chance to improve the diagnosis of the disease, which has been troubled by misdiagnosis rates near 20% for quite some time, despite the rapidly improved understanding of its pathology. In his discussion with NeurologyLive, Calabresi highlighted some of the key changes to the criteria and the importance of disseminating these updates to the wider MS community. As he put it, “there are quite a few changes and it’s going to be a little confusing. We’re going to have to have tables and more detailed methodologies about how to use the imaging and fluid biomarker applications.”
Click here for more coverage of ECTRIMS 2024.
