Inclusion of Optic Nerve Assessed by Visual Evoked Potentials in Dissemination in Space Criteria for the Diagnosis of Multiple Sclerosis
DOI:
https://doi.org/10.46531/sinapse/AO/240003/2024Keywords:
Demyelinating Diseases, Evoked Potentials, Visual, Magnetic Resonance Imaging, Multiple Sclerosis/diagnosis, Multiple Sclerosis/diagnostic imaging, Optic Nerve/diagnostic imagingAbstract
Introduction: Optic nerve (ON) inclusion as the fifth location in dissemination in space (DIS) for the diagnosis of multiple sclerosis (MS) was proposed in 2016 by the Magnetic Resonance Imaging in Multiple Sclerosis Group. However, there was insufficient evidence to include this recommendation in the 2017 revision of McDonald criteria. Our objective was to investigate the effect of including ON involvement assessed by visual evoked potentials (VEP) as the fifth location in DIS criteria for MS diagnosis, in patients with a typical clinically isolated syndrome (CIS).Methods: We studied consecutive patients presenting with typical CIS between 2012 and 2019 from two Portuguese hospitals with complete initial evaluation, including brain and spine magnetic resonance imaging (MRI) and VEP. McDonald 2017 criteria and a set of modified criteria that included ON involvement in DIS assessed by VEP were applied retrospectively. Performance of the two sets of criteria to predict development of clinically definite multiple sclerosis (CDMS) and/or MRI activity during follow-up was evaluated.
Results: Seventy-six patients were included, 25% of which had an ON CIS. Asymptomatic ON involvement on VEP was found in 12.3% of non-ON CIS. Twenty-seven (35.5%) patients converted to CDMS and 37 (48.7%) had MRI activity during follow-up (median = 3.12 years, 1.04 - 8.36). Fifty-nine percent of patients begun disease-modifying treatment before conversion to CDMS. Modified DIS criteria in combination with dissemination in time were more sensitive (77.8% vs 74.1%), but less specific (57.1% vs 61.2%) to predict CDMS, and were more sensitive (73.2% vs 65.9%) with equal specificity (65.7% vs 65.7%) to predict CDMS or MRI activity, but these differences were not statistically significant. Modified criteria allowed for the correct diagnosis of 3 additional patients at baseline (42/76 vs 39/76), in average 9 months before fulfilment of McDonald 2017 criteria.
Conclusion: Although inclusion of ON involvement assessed by VEP in DIS criteria led to the accurate identification of more MS patients, in our sample it did not allow for statistically significant increase in sensitivity for MS diagnosis. Even so, our work supports the need for discussion of the inclusion of ON in DIS criteria in the future revision of MS diagnostic criteria.
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Copyright (c) 2024 Sofia Delgado, Ângelo Timóteo, Joana Moniz Dionísio, Ana Rodrigues, Ana Arraiolos, Pedro Lopes das Neves, André Rêgo, José Vale, Vasco Salgado, Lia Leitão, Mariana Santos
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