Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany.
2024 McDonald criteria found more optic nerve-based multiple sclerosis diagnoses than 2017 criteria.
Applying the 2024-revised McDonald criteria for multiple sclerosis using conventional diagnostic tools: a single-centre prospective cohort study in Germany.
The 2024-revised McDonald criteria may enable earlier diagnosis of multiple sclerosis (multiple sclerosis) through inclusion of optic nerve involvement as fifth neuroanatomical topography, novel MRI biomarkers, cerebrospinal fluid (cerebrospinal fluid) kappa free light chains (kappa free light chains), and classification of radiologically isolated syndrome (radiologically isolated syndrome) as multiple sclerosis.
Underwent conventional diagnostic work-up according to the 2017-revised McDonald criteria, including contrast-enhanced MRI, visual evoked potentials (visual evoked potentials), and cerebrospinal fluid analysis.
Applying the 2024-revised criteria, 201/215 individuals (93.5%) fulfilled diagnostic criteria for multiple sclerosis versus 181/215 (84%) using the 2017 revision (p < 0.0001).
Visual evoked potentials identified optic nerve lesions in 89% of cases.
Overall, 102/201 (51%) individuals fulfilled diagnostic criteria based on MRI findings alone, whereas 99/201 (49%) additionally required inflammatory cerebrospinal fluid findings and dissemination in time.
Application of selected components of the 2024-revised McDonald criteria increased the proportion of individuals fulfilling the diagnostic criteria, mainly through inclusion of optic nerve involvement and recognition of radiologically isolated syndrome.
cerebrospinal fluid analysis remained important for diagnosis and differential diagnostics. Further studies should evaluate the contribution of novel imaging biomarkers.