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MOST NEUROLOGISTS IN SCOTLAND DO NOT USE THE MCDONALD 2010 CRITERIA TO DIAGNOSE MULTIPLE SCLEROSIS
  1. Ruby Lumley,
  2. Richard Davenport,
  3. Anna Williams
  1. Department of Clinical Neurosciences, University of Edinburgh

    Abstract

    Introduction and Aims Diagnostic criteria for Multiple Sclerosis (MS) have continuously evolved since Schumaker in 1965 up to the present McDonald (2010) criteria, progressively incorporating advances in diagnostic technology, particularly magnetic resonance imaging (MRI). The emergence of successful, but potentially toxic, disease modifying therapies has meant that an earlier and more accurate diagnosis of MS may be more important now than in the past. Although the current diagnostic criteria allow for a diagnosis of MS after a single clinical attack but with supportive MRI findings, our impression was that there was a clinical reluctance to use such criteria, preferring in many cases to base a diagnosis of MS on the time honoured principle of two or more clinical presentations disseminated in time and space. This study aimed to test this hypothesis by auditing how Scottish neurologists diagnose MS in clinical practice and to what extent they use the 2010 McDonald criteria in patients presenting with a clinically isolated syndrome (CIS).

    Methods 65 neurologists (consultants and trainees) from centres across Scotland completed a Survey Monkey generated questionnaire which included testing their approach to a hypothetical, yet typical CIS case study, as well as auditing their diagnostic approach in response to various questions, including their familiarity and use of the 2010 McDonald criteria.

    Results Most (97%) Scottish neurologists were familiar with the 2010 McDonald criteria but only 53% routinely applied it in clinical practice, although we will present data suggesting that the true figure is significantly lower. In response to the case study, 60% would wait for a further clinical relapse to confirm dissemination in time, rather than rely on follow up MRI, and only 9% diagnosed MS from the hypothetical CIS–challenging the above figure of 53% routinely applying the criteria in their clinical practice. We present further data concerning the use of other investigations (CSF analysis, evoked potentials, blood testing), as well as attitudes to treatment of CIS, together with some evidence of variation between consultants and trainees, and even perhaps a geographical influence.

    Conclusion Our data indicate significant variation in practice amongst Scottish neurologists regarding the diagnosis of MS. It seems that few are enthusiastic about applying the current diagnostic criteria after a single attack (CIS), even if the diagnostic criteria are met. Case mix, clinical expertise and experience may explain some of this variation, and given the lack of evidence for aggressive treatment of CIS, such diagnostic caution is perhaps justified. It would be of interest to repeat the audit UK wide, and internationally, and our prediction would be that some countries may embrace the criteria with more enthusiasm than others. This will inevitably affect future epidemiological and therapeutic studies.

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