Impact of Optic Nerve Inclusion on Early MS Diagnosis and Treatment

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EP: 1.Ep 1: Role of Neuro-Ophthalmologists in Care Paradigm of Multiple Sclerosis

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EP: 2.Impact of Optic Nerve Inclusion on Early MS Diagnosis and Treatment

Multiple sclerosis (MS) is a complex, chronic neurological condition that can affect a wide range of systems within the body, including the visual system. The interplay between the eyes and MS is of particular importance, as optic neuritis, a common manifestation, can significantly impact patient outcomes and quality of life. Understanding how MS affects vision and the underlying pathophysiological mechanisms is essential for clinicians to provide timely and accurate diagnoses, as well as to tailor treatment strategies aimed at minimizing visual impairment.

In this 5-episode series, two experienced clinicians from Northwestern University delve into the nuanced relationship between MS and the eyes, offering insights into the latest clinical practices, advancements in drug development, and evolving standards of care. The clinicians, Elena Grebenciucova, MD, and Neena Cherayil, MD, cover a range of topics, including the critical role of neuro-ophthalmologists in the care of MS, the inclusion of the optic nerve to the 2024 McDonald Diagnostic Criteria, the education needed to translate the latest changes to the diagnostic criteria, and the needed research to understand more about the impact of MS on the eyes.

In episode 2, the clinicians discuss the benefits of incorporating optic nerve involvement into the diagnostic criteria for MS, particularly in relation to the McDonald criteria. Grebenciucova, an assistant professor of neurology, and Cherayil, MD, an assistant professor of neurology and ophthalmology, highlight how the inclusion of optic nerve lesions as part of dissemination in time and space helps provide a more definitive diagnosis, allowing for earlier treatment initiation. The conversation emphasizes how this revision enhances diagnostic sensitivity without significantly affecting specificity, ultimately helping patients receive disease-modifying therapies sooner and improving long-term outcomes.

Transcript edited for clarity.

Marco Meglio: With these latest revisions, you know, what added benefit is there by including the optic nerve as a diagnostic region? Just talk a little bit about the added benefit, as well as the long-term impacts of these major changes.

Elena Grebenciucova, MD: Now that we can involve optic nerve enhancement in dissemination in time and space, it’s really critical. Previously, we would have diagnosed a patient with optic neuritis and only a couple of, say, non-enhancing lesions in the brain, and we would have diagnosed them with clinically isolated syndrome. And while for many of them, we obviously want to start treatment early, for some patients, the message sounded like, “Well, maybe that's not definitive MS yet. Maybe I should wait.” But now, we can actually diagnostically state, "Yes, you have optic neuritis, you have MS-defining lesions, and you officially qualify for the diagnosis of MS" by the McDonald criteria. That's really meaningful. It allows us to start treatment earlier, and it allows us to settle on a diagnosis earlier, which, of course, still involves excluding other possibilities, like neuromyelitis optica. And this is where ophthalmologists, like Dr. Chenail, come into play as well, and are superbly helpful in understanding and making sure that the optic neuritis we’re seeing is truly typical of what we see in MS.

Neena Cherayil, MD: I'd say the optic nerve is something we've wanted for some time, and having it as a fifth region in the dissemination in space criteria really elevates the sensitivity without compromising much specificity. It also helps get patients who are at high risk of having other clinical attacks onto disease-modifying therapy faster. So, a win-win.