Application of the 2024 McDonald criteria in the International Acute Optic Neuritis Network
Authors
- Adi Wilf-Yarkoni
- Hadas Stiebel-Kalish
- Frederike Cosima Oertel
- Ricardo Alonso
- Ayse Altintas
- Carlos Alvarado
- Charlotte Bereuter
- Omer Bialer
- Luca Bollo
- Atira Bick
- Francesca Bosello
- Yolanda Blanco
- Eser Bulus
- Sara Carta
- Fiona Chan
- John J. Chen
- Jessy Chen
- Leila Cohen
- Yamit Cohen-Tayar
- Edgar Carnero Contentti
- Russell C. Dale
- Josep Dalmau
- Adi Vaknin-Dembinsky
- Aviv Fineberg
- Eoin P. Flanagan
- Lorna Galleguillos
- Azzam Ghaben
- Matteo Gastaldi
- Jonathan A. Gernert
- Giacomo Greco
- Julian Haas
- Joachim Havla
- Christoph Heesen
- Mark Andrew Hellmann
- Frank Konietschke
- Maria Isabel Leite
- Nadège Leprêtre
- Netta Levin
- Michael Levy
- Pablo Lopez
- Itay Lotan
- Maria Belen Luis
- Sara Mariotto
- Christina Mayer
- Cassandra Ocampo
- Susana Ochoa
- Maja Olszewska
- Jacqueline Palace
- Lekha Pandit
- Axel Petzold
- Sean J. Pittock
- Jana Lízrová Preiningerová
- Sudarshini Ramanathan
- Natthapon Rattanathamsakul
- Sara Samadzadeh
- Bernardo Sanchez Dalmau
- Jaume Sastre-Garriga
- Dario Scocco
- Fu-Dong Shi
- Jemal Shifa
- Iliya Simantov
- Sasitorn Siritho
- Pia Sophie Sperber
- Nanthaya Tisivipat
- Isabel Torres
- José Luis Peralta-Uribe
- Alvaro Jose Meija Vergara
- Ángela Vidal-Jordana
- Yihan Wang
- Ti Wu
- Tianrong Yeo
- Sol Zamir
- Luis Alfonso Zarco
- Hanna Zausinger
- Kelvin Zhenghao Li
- Hanna G. Zimmermann
- Jeffrey L. Bennett
- Friedemann Paul
- Philipp Klyscz
- Susanna Asseyer
Journal
- SSRN
Citation
- SSRN
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.