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| Item Type: | Preprint |
|---|---|
| Title: | Application of the 2024 McDonald criteria in the International Acute Optic Neuritis Network |
| Creators Name: | Wilf-Yarkoni, Adi, Stiebel-Kalish, Hadas, Oertel, Frederike Cosima, Alonso, Ricardo, Altintas, Ayse, Alvarado, Carlos, Bereuter, Charlotte, Bialer, Omer, Bollo, Luca, Bick, Atira, Bosello, Francesca, Blanco, Yolanda, Bulus, Eser, Carta, Sara, Chan, Fiona, Chen, John J., Chen, Jessy, Cohen, Leila, Cohen-Tayar, Yamit, Contentti, Edgar Carnero, Dale, Russell C., Dalmau, Josep, Vaknin-Dembinsky, Adi, Fineberg, Aviv, Flanagan, Eoin P., Galleguillos, Lorna, Ghaben, Azzam, Gastaldi, Matteo, Gernert, Jonathan A., Greco, Giacomo, Haas, Julian, Havla, Joachim, Heesen, Christoph, Hellmann, Mark Andrew, Konietschke, Frank, Leite, Maria Isabel, Leprêtre, Nadège, Levin, Netta, Levy, Michael, Lopez, Pablo, Lotan, Itay, Luis, Maria Belen, Mariotto, Sara, Mayer, Christina, Ocampo, Cassandra, Ochoa, Susana, Olszewska, Maja, Palace, Jacqueline, Pandit, Lekha, Petzold, Axel, Pittock, Sean J., Preiningerová, Jana Lízrová, Ramanathan, Sudarshini, Rattanathamsakul, Natthapon, Samadzadeh, Sara, Sanchez Dalmau, Bernardo, Sastre-Garriga, Jaume, Scocco, Dario, Shi, Fu-Dong, Shifa, Jemal, Simantov, Iliya, Siritho, Sasitorn, Sperber, Pia Sophie, Tisivipat, Nanthaya, Torres, Isabel, Peralta-Uribe, José Luis, Vergara, Alvaro Jose Meija, Vidal-Jordana, Ángela, Wang, Yihan, Wu, Ti, Yeo, Tianrong, Zamir, Sol, Zarco, Luis Alfonso, Zausinger, Hanna, Li, Kelvin Zhenghao, Zimmermann, Hanna G., Bennett, Jeffrey L., Paul, Friedemann, Klyscz, Philipp and Asseyer, Susanna |
| Abstract: | BACKGROUND: The 2024 McDonald criteria for multiple sclerosis (MS) incorporate optic nerve lesions as a fifth topography for dissemination in space (DIS), and other additional diagnostic features. We evaluated their performance in acute optic neuritis (ON) patients within the global Acute Optic Neuritis Network (ACON). METHODS: In this ongoing, prospective, multicenter study (clinicaltrials.gov, identifier: NCT05605951), we applied the 2024 McDonald criteria to 250 patients with a first-ever ON (enrolment period August 2020 – December 2024) from 22 centers in 14 countries across six continents. We included 61 patients with idiopathic ON (iON), 53 with clinically isolated syndrome and 64 with MS according to 2017 McDonald criteria (2017-CIS, 2017-MS), 22 with aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), and 50 with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). We assessed the sensitivity of the 2017 and 2024 McDonald criteria using the MS ”at-risk” population (defined by criteria specific for DIS or dissemination in time (DIT) using MRI). Specificity was measured using the AQP4-IgG+NMOSD and MOGAD cohorts. FINDINGS: All 2017-MS patients (64/64, 100%) fulfilled the 2024 criteria and 33/53 (62%) 2017-CIS patients were reclassified as MS by the 2024 criteria. Additionally, 18% of AQP4-IgG+NMOSD and 14% of MOGAD patients met the 2024 McDonald criteria. The sensitivity of the 2017 and 2024 criteria were 55% (95%-CI 45-64) and 83% (95%-CI 75-89); specificity was 100% (95%-CI 95-100) and 85% (74-92), and diagnostic accuracy was 72% (95%-CI 65-78) and 84% (95%-CI 76-89), respectively. Visual evoked potentials and optic coherence tomography demonstrated higher sensitivity than MRI for the detection of DIS using the 2024 criteria; however, MRI yielded higher specificity. Due to limited use, the impact of new MRI metrics and KFLC were not assessed. INTERPRETATION: The 2024 McDonald criteria enhance diagnostic sensitivity in ON-related CIS, enabling earlier MS diagnosis, but reduce specificity in AQP4-IgG+NMOSD and MOGAD. |
| Source: | SSRN |
| Publisher: | Elsevier |
| Article Number: | 5702399 |
| Date: | 6 November 2025 |
| Official Publication: | https://doi.org/10.2139/ssrn.5702399 |
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