Application of the McDonald criteria in Latin America

Abstract

The diagnosis of multiple sclerosis (MS) is based on neurological symptoms and signs, alongside evidence of dissemination of central nervous system (CNS) lesions in space and time. In the absence of a sensitive and specific diagnostic test, diagnostic criteria are needed for diagnosing MS. The caveat to the application of the McDonald criteria is that alternative diagnoses must be excluded. The prevalence, clinical phenotype and the differential diagnosis of MS may have variations in different populations, especially in Latin America (LATAM). Considering that MS diagnostic criteria were developed with data gathered largely from adult Caucasian European and North American populations, their applicability and accuracy in ethnical/genetic diverse populations may be affected. There are scarce data in our region about the reliability of MS criteria.

The role of ethnicity and native-country income in multiple sclerosis: the Italian multicentre study (MS-MigIT)

“…Moreover, the retrospective collection of data does not allow to rule out that the registration of the date of onset was postponed due to a misdiagnosis among OEG. Indeed, diagnosing MS in OEG is still challenging considering the limitation of available data and their under-representation in clinical trial [ 32 , 33 ]. Therefore, our findings may be confounded by a longer pre-clinical phase over which patients had developed more MS lesions and that could explain also the higher disability reported at the last clinical follow-up.…”

Performance of McDonald 2017 multiple sclerosis diagnostic criteria and evaluation of genetic ancestry in patients with a first demyelinating event in Argentina

“…In addition, regional infectious diseases, nutritional deficits simulating MS, as well as other local factors may limit extrapolation of the criteria to other world regions. 15 Collaborative efforts conducted in the region have increased knowledge on MS epidemiology, 16 but information on MS diagnostic criteria performance in Latin America is still scarce. 7,17 In this study, we compared the outcomes of 2017 versus 2010 McDonald criteria in predicting CDMS, in a cohort of patients experiencing their first demyelinating event.…”

Inclusion of optic neuritis in dissemination in space improves the performance of McDonald 2017 criteria in Hispanic people with suspected multiple sclerosis

“…Several studies have investigated the performance of the McDonald 2017 criteria, 1,17,18 including several among cohorts of Hispanic patients in Latin America. [3][4][5] The performance of the McDonald 2017 criteria in an Argentinian cohort reported a sensitivity of 84% and a specificity of 14%. 19 It is noteworthy that our findings include a lower sensitivity (64%) but markedly higher specificity (40%).…”

“…1 Studies investigating the performance of the McDonald 2017 criteria in cohorts with Hispanic background are few and have primarily been conducted in Latin America, with a relative paucity of data from patients in the United States. 3–5…”

“…1 Studies investigating the performance of the McDonald 2017 criteria in cohorts with Hispanic background are few and have primarily been conducted in Latin America, with a relative paucity of data from patients in the United States. [3][4][5] Hispanic people in the United States have been underrepresented in research regarding MS 6 including clinical trials. 6,7 Hispanic people with MS in the southwest and western regions of the United States are two times more likely to present with optic neuritis (ON) compared to non-Hispanic White people.…”