Validity of the McDonald criteria in predicting second events in multiple sclerosis

BACKGROUND

The McDonald criteria are designed for predicting the second event in multiple sclerosis. With several revisions made to the McDonald criteria, the criteria get much easier to use, but what about the diagnostic validity? This research is conducted for evaluating the diagnostic validity of the McDonald criteria in multiple sclerosis.

METHODS

Pubmed, Web of Science, Cochrane Library were systematically searched with keywords of "Multiple sclerosis" and "McDonald criteria" from, January 1^st, 2010 to 27^th, February 2020. The methodological quality of each study is assessed by Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). All of the statistics are analyzed by software STATA 12.0 and Meta-Disc 1.4.

RESULTS

Twenty articles are finally included according to the inclusion and exclusion criteria. Both the 2010 and 2017 McDonald criteria have excellent performance in predicting second events in multiple sclerosis. The 2017 McDonald criteria have better performance compared to the 2010 McDonald criteria (AUC, 0.83 vs 0.77). It is increased in sensitivity but decreased in specificity.

CONCLUSION

The McDonald criteria are useful in predicting second events in multiple sclerosis. The 2017 McDonald criteria have better performance than the 2010 McDonald criteria with increased sensitivity but decreased specificity.

Demyelinating diseases in Asia

PURPOSE OF REVIEW

The present review aims to discuss the recent advances in inflammatory demyelinating diseases of the central nervous system in Asia.

RECENT FINDINGS

Prevalence of multiple sclerosis (MS) in Asia is lower than that in Western countries, although it has been increasing recently. Meanwhile, there seems to be no major difference in neuromyelitis optica (NMO) prevalence in various regions or ethnicities. Thus, the ratios of NMO/NMO spectrum disorder (NMOSD) to MS are higher in Asia as compared with Western countries, indicating that the differential diagnosis between NMO/NMOSD and MS is a major challenge in Asia. Although the detection of aquaporin-4 (AQP4)-antibody is critical in distinguishing NMO/NMOSD from MS, some patients with NMO/NMOSD phenotype are seronegative for AQP4-antibody, and a fraction of those patients possess autoantibody against myelin oligodendrocyte glycoprotein. The clinical profile of Asian MS seems to be essentially similar to that in Western MS after careful exclusion of NMO/NMOSD, although some unique genetic and/or environmental factors may modify the disease in Asians.

SUMMARY

MS prevalence has been low but is increasing in Asia. In contrast, NMO/NMOSD prevalence seems relatively constant in the world. Asian MS is not fundamentally different from Western MS, but some genetic and/or environmental differences may cause some features unique to Asian patients.

Clinical characteristics and outcome of multiple sclerosis in Korea: does multiple sclerosis in Korea really differ from that in the Caucasian populations?

Background:

Multiple sclerosis (MS) in Asia is thought to have different clinical characteristics from MS in Western countries; however, previous studies in Asia were performed without properly differentiating neuromyelitis optica (NMO) from MS.

Objectives:

To evaluate the clinical characteristics of MS in Korea after careful exclusion of potential explanations other than MS, particularly NMO spectrum disorder (NMOSD).

Methods:

This study is a retrospective review of consecutive MS patients attending five referral hospitals in Korea. All patients’ MS diagnoses were re-evaluated.

Results:

Of the 105 patients, 70 were female and 35 were male. The mean age of onset was 30.4 years and the mean disease duration was 5.4 years. On initial magnetic resonance imaging (MRI), 58% and 64% fulfilled the criteria for dissemination in space for the 2005 and 2010 McDonald criteria, respectively. Spinal cord lesions were observed in 78% of patients, primarily present as multiple small lesions with a mean length of 0.9 vertebral segments. The median time from disease onset to an Expanded Disability Status Scale 6 was 20 years.

Conclusions:

After careful exclusion of NMOSD, we found that the clinical pattern of MS in Korea does not fundamentally differ from that seen in Western countries.

HLA-DPB1 0501 is associated with susceptibility to anti-aquaporin-4 antibodies positive neuromyelitis optica in southern Han Chinese

OBJECTIVES

To analyze the role of HLA-DRB1 and -DPB1 alleles in the pathogenesis of neuromyelitis optica (NMO) and multiple sclerosis in Southern Han Chinese.

METHODS

Thirty serum anti-aquaporin 4 antibodies (AQP4-Ab)-positive NMO patients, 53 conventional multiple sclerosis (C-MS) patients, and 93 controls (CTLs) were enrolled. The HLA-DRB1 and -DPB1 alleles of the subjects were determined by sequencing-based typing (SBT).

RESULTS

The frequency of the DRB1 0901 was lower in NMO patients than in CTLs (P(uncorr)=0.022, OR: 0.194, 95% CI: 0.043-0.876), and DRB1 1602 was higher in NMO patients than in C-MS (P(uncorr)=0.038, OR: 3.491, 95% CI: 1.024-11.896) and CTLs (P(uncorr)=0.051, OR: 2.711, 95% CI: 0.971-7.556). The frequency of DPB1 0501 was significant higher in NMO patients than in C-MS (P(uncorr)=0.018, OR: 4.629, 95% CI: 1.235-17.350) and CTLs (P(uncorr)=0.001, P(corr)=0.022, OR: 7.096, 95% CI: 2.011-25.044).

CONCLUSIONS

DPB1 0501 correlates with risk of AQP4-Ab positive NMO in Southern Han Chinese.