'Burning Debate' on McDonald Diagnostic Criteria in MS

Liz Neporent

October 12, 2018

BERLIN — This year's 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2018 is underway at the expansive City Cube Messe conference center in Berlin. With more than 10,000 delegates in attendance, it is the world's largest annual gathering devoted to basic and clinical research in multiple sclerosis (MS).

An early session highlighted the new McDonald diagnostic criteria and its use in clinical practice. The criteria, revised late last year, are controversial. Although meant to speed diagnosis and treatment of MS, some experts believe it also results in over-diagnosis or misdiagnosis.

Emmanuelle Waubant, MD, professor of neurology at the University of California, San Francisco, introduced the session entitled "Burning Debate: The new McDonald diagnostic criteria are controversial making them difficult to use in clinical practice."

Jiwon Oh, MD, of the University of Toronto, Ontario, Canada, took the "no" side of the debate, suggesting the new criteria are not difficult to use in practice, pointing out that there is a scientific rationale for the update and the criteria can be easily administered. The criteria increase the sensitivity of diagnostics without sacrificing much specificity. And it will save time and resources for the patient and neurologist, she pointed out.

Frauke Zipp, MD, of the University of Mainz in Germany, was on the "yes" side, supporting the conclusion that the criteria are difficult to use in practice. She said she felt the revisions force treatment too early and that there are also adverse events, such as allergic reactions and malignancies, to consider.

At the end of the debate, the presenters took questions from the packed auditorium and, in an unusual twist, also solicited questions and comments from a virtual audience on Twitter. Almost 60 tweets in 15 minutes streamed onto a large overhead screen during the Q&A session.

Twitter users did ask thoughtful questions but also began their own mini-debate about the pros and cons of adopting the criteria. A quick online poll came to an overwhelming consensus that the new criteria should be adopted, with only 13% saying it was too difficult to use in clinical practice.

The debate over the pros and cons of the new criteria, which were formulated by a 30-member expert panel and published late last year (Lancet Neurology. 2018;17:P162-173), is expected to continue — both on- and off-line — for the duration of the conference. Five new papers on the impact of the criteria will be presented at ECTRIMS over the next several days. 

34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2018. October 10, 2018.

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