This interesting study from Dublin looked at the sensitivity of the
diagnostic criteria for primary progressive MS. They looked at 95 new
people with PPMS diagnosed between 1990 and 2011. The group assessed
baseline clinical details as well as paraclinical evaluations including
MRI brain, spinal cord, cerebrospinal fluid and visually evoked
responses (VERs). 88 PPMS patients had at least two diagnostic
investigations. Results revealed that the sensitivity of Thompson’s and
the McDonald 2001 criteria was 64%, the McDonald 2010 revisions gave the
highest sensitivity at 77%, and the McDonald 2005 criteria had
intermediate sensitivity at 74%. They found that the combination of CSF
oligoclonal bands (CSFOBs) and MRI of the brain yielded the greatest
number of patients demonstrating dissemination in space on only two
investigations. The diagnostic sensitivity increased to 84% when the
number of spinal cord lesions was reduced to one.
diagnostic sensitivity for PPMS would increase if an alternative
criterion was considered requiring two of the following: i) MRI of the
brain with one or more lesions in two of three regions typical for
demyelination; ii) the presence of one T2-weighted spinal cord plaque,
typical of demyelination; iii) CSFOBs would increase the diagnostic
sensitivity for PPMS.
Authors: Kelly S, Kinsella K, Duggan M, Tubridy N, McGuigan C, Hutchinson M.
Source: Mult Scler. 2012 Nov 6. [Epub ahead of print]
Read the abstract