McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity

Schwenkenbecher, Philipp; Sarikidi, Anastasia; Wurster, Ulrich; Bronzlik, Paul; Raab, Peter; Stangel, Martin; Pul, Refik; Skripuletz, Thomas

doi:10.3390/ijms17091592

Cited by 35 publications

(37 citation statements)

References 29 publications

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“…Fourthly, on comparing patient characteristics between MS patients diagnosed with RRMS according to the 2010 versus 2017 criteria, it is apparent that optic neuritis was more common as presenting syndrome and OCBs were more frequent. The increased frequency of CSF specific OCBs is in contrast to a study comparing the 2005 versus 2010 McDonald criteria where sensitivity was doubled but OCB rates did not significantly differ . Interestingly, the optic nerve constitutes an anatomic site where diagnostic uncertainty regarding chronicity after a first demyelinating attack is most expressed.…”

Section: Discussionmentioning

confidence: 60%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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Background and purpose For the diagnosis of relapsing–remitting multiple sclerosis (RRMS), the revised 2017 McDonald criteria include cerebrospinal fluid specific oligoclonal bands as a new criterion for dissemination in time. Amongst other things, one expectation of the new criteria is to marginalize the diagnosis of clinically isolated syndrome (CIS), thus allowing for a faster and at the same time still reliable diagnosis of RRMS. Methods In this study, data from an unselected patient cohort with a typical CIS and dissemination in space at a large German Multiple Sclerosis Center from 2013 to 2016 were re‐analysed to compare differences in diagnosing RRMS with the 2017 versus 2010 McDonald criteria in everyday practice. Results Out of a cohort of 290 patients presenting with a typical first demyelinating event, 52% (152 patients) with the diagnosis of RRMS and 48% (138 patients) with the diagnosis of CIS according to the 2010 McDonald criteria were identified. The application of the 2017 McDonald criteria in the same patients increased the number of definite RRMS to 94% (273), thus leaving only 6% of patients with the diagnosis of CIS. The reason for this shift was the presence of cerebrospinal fluid specific oligoclonal bands which was found in 92.7% of the total population and in all patients with 2017 McDonald RRMS. Over a mean follow‐up of 1.5 years, 50% of patients formerly diagnosed with CIS who are now RRMS also fulfilled the 2010 McDonald criteria. Conclusions Our data support the use of the 2017 McDonald criteria for a more sensitive, but not that specific, diagnosis of RRMS in everyday practice.

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Section: Discussionmentioning

confidence: 60%

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Lee

Peschke

Utz

et al. 2018

Euro J of Neurology

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“…CSF and serum were analysed by routine methods [17–19]. CSF cells were counted manually with a Fuchs-Rosenthal counting chamber.…”

Section: Methodsmentioning

confidence: 99%

Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization

et al. 2017

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BackgroundNeuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital.MethodsWe retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study.ResultsSixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood.ConclusionIn conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.

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“…In contrast, inflammatory CSF changes occur at a considerably lower rate in patients with Sjögren's syndrome compared to patients with multiple sclerosis. In a recent survey, we could demonstrate that in multiple sclerosis diagnosed according to the McDonald criteria of 2010 pleocytosis occurred in 65% and OCBs in 96% of the patients [42] . Besides lower frequency of OCBs in primary Sjögren's syndrome, the number of OCBs was considerably reduced with a mean of 7 bands (highest value: 13) against a mean of 16 bands (maximal value: 45 bands) in multiple sclerosis.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Findings in Neurological Diseases Associated with Sjögren's Syndrome

Pars

Pul²,

Schwenkenbecher³

et al. 2016

Eur Neurol

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Background: Sjögren's syndrome is a chronic autoimmune-mediated disease that can cause a variety of neurological manifestations. Methods: This study investigated characteristics of clinical and cerebrospinal fluid (CSF) features in patients with neurological diseases associated with Sjögren's syndrome. Eighty-two patients were examined separately according to the presence of Sjögren's syndrome alone or in combination with other autoimmune diseases. Results: In the 47 patients with primary Sjögren's syndrome, peripheral neuropathy (57%) was found most frequently, followed by the involvement of the central nervous system (CNS; 17%), cranial neuropathy (15%), and myalgia (11%). These patients did not display consistent signs of inflammation in the CSF. Slight pleocytosis of 8-107 cells/µL was found in patients with peripheral neuropathy (9%), cranial neuropathy (20%), and CNS involvement (25%). Oligoclonal bands indicating intrathecal IgG synthesis occurred in 26% of patients with peripheral neuropathy, 20% of patients with cranial neuropathy, and 25% of patients with CNS involvement. Conclusions: In patients with Sjögren's syndrome and neurological manifestations, inflammatory CSF changes were rarely found and did not show a characteristic pattern irrespective of peripheral or central genesis of neurological deficits. Analysis of the CSF presents therefore an important diagnostic procedure to exclude other autoimmune and infectious diseases.

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McDonald Criteria 2010 and 2005 Compared: Persistence of High Oligoclonal Band Prevalence Despite Almost Doubled Diagnostic Sensitivity

Cited by 35 publications

References 29 publications

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Diagnostic value of the 2017 McDonald criteria in patients with a first demyelinating event suggestive of relapsing–remitting multiple sclerosis

Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization

Cerebrospinal Fluid Findings in Neurological Diseases Associated with Sjögren's Syndrome

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