Researchers at the Universitat Autònoma de Barcelona in Spain found that including features of the optic nerve in diagnostic criteria for multiple sclerosis (MS) improved diagnostic performance by increasing sensitivity without lowering specificity, as shown by study results published in Neurology .
The data for this study comes from a prospective study of 1238 patients diagnosed with clinically isolated syndrome after performing a single magnetic resonance imaging (MRI) scan between 1995 and 2017. The investigators retrospectively assessed the visually evoked potential data using patient records. They divided patients into cohorts for risk assessment (n = 388) and diagnostic criteria performance (n = 151) to validate whether adding information about the optic nerve improved the diagnostic criteria for MS.
At diagnosis of clinically isolated syndrome, patients had a mean age of 31.6 years (standard deviation) [SD]8.2 years). 68% of the patients were women; 63.6% had non-optic neuritis; 58.8% were positive for oligoclonal bands; 71.2% had an abnormal MRI; 37.8% had abnormal visual evoked potentials; and the mean expanded disability status scale was 1 (range 0-5.5).
In cohort 1, people with higher diagnostic criteria had an increased risk of a second seizure according to 1 criterion (hazard ratio) [HR] 5.6; 95% CI, 1.9-16.5) were 5 criteria (HR 22.7; 95% CI, 7.9-65.7).
The criteria for proliferation in space 2017 (DIS) showed a similar risk of a second attack (HR 4.3; 95% CI 2.8-6.5) as the modified DIS (modDIS) (HR 4.8; 95 % CI 3.0-7.5). Due to the involvement of the optic nerve, the risk of a second seizure in patients with optic neuritis using the modDIS (HR 4.3; 95% CI 1.9-9.6) compared to 2017 DIS (HR 3.8; 95% CI) than forecast increased 1.8-8.0).
In cohort 2, the identification of the risk of a second seizure after 10 years according to DIS 2017 was less precise (sensitivity 79.2%; specificity 52.4%; accuracy 75.5%; positive predictive value) [PPV]91.1%; negative predictive value [NPV]28.9%) compared to the modDIS (sensitivity 82.3%; specificity 52.4%; accuracy 78.1%; PPV 91.4%; NPV 32.3%).
Similarly, in 2017 the DIS predicted a second seizure after 10 years with poorer overall performance only in patients with optic neuritis (sensitivity 69.7%; specificity 57.1%; accuracy 67.5%; PPV 88.5%; NPV 28, 6%)) compared with the modDIS criteria (sensitivity 75.8%; specificity 57.1%; accuracy 72.5%; PPV 89.3%; NPV 33.3%).
This study could have contained some selection biases, as the researchers only included patients with complete medical records in the two cohorts analyzed here.
Following their findings, the study researchers concluded that “adding the optic nerve to the current DID criteria slightly increased accuracy and sensitivity without reducing specificity,” and provided “additional evidence supporting optic nerve uptake.” as a new speaking region in the diagnostic criteria. ”
Disclosure: Several authors have declared their affiliations with the industry. For a full list of the authors’ claims, see the original article.
Vidal-Jordana A., Rovira A., Arrambide G. et al. Optic nerve region in the diagnosis of multiple sclerosis: the utility of visual evoked potentials. Published online December 16, 2020. Neurology. doi: 10.1212 / WNL.0000000000011339