Introduction of new diagnostic criteria for multiple sclerosis and time interval between disease onset and MS diagnosis
ECTRIMS Online Library. Stawiarz L. 09/11/19; 279422; 99
Leszek Stawiarz
Leszek Stawiarz
Contributions
Abstract

Abstract: 99

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis

L. Stawiarz1, E. Hagel2, J. Hillert1

1Department of Clinical Neuroscience (CNS), 2Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden

Background: The earlier multiple sclerosis (MS) diagnostic criteria of Schumacher and Poser were mostly based on clinical symptoms and signs. Improved insights into MS course and the inclusion of magnetic resonance imaging (MRI) to detect brain lesions, allowed an MS diagnosis to be made stepwise, earlier based on Barkhof-Tintoré's MRI criteria and leading to a series of new McDonald's criteria.
Objectives: To study the interval from first symptom of MS to the date of diagnosis in relation to the introduction of upgraded MS diagnostic criteria from conservative to more liberal ones.
Methods: We used data of 19,600 MS patients from the Swedish MS registry collected between 1996 and 2019. 92.5% had a registered date of onset and 85.1% a date of diagnosis. 62% of dates of onsets and diagnosis were registered prospectively whereas 38% were retrospectively collected from medical records or other previous data bases. Kaplan-Meier estimator and plots were applied. Survival probabilities were evaluated for 5 diagnosis epoch groups according to the diagnostic criteria advised at the time: 1965-1982 Schumacher, 1983-2000 Poser, 2001-2004 McDonald's first version, 2005-2009 revisions of 2005, 2010-2016 revisions of 2010 and 2017-2019 revisions of 2017. Time to failure was defined as time from onset to diagnosis with right censoring for deceased, migrated and other withdrawals from the registry.
Results: Relative to the time epoch, when Poser criteria were standard, time from MS onset to diagnosis decreased step-wise with the introduction on new diagnostic criteria. For instance, using Poser criteria, 50% of all the patients received a diagnosis within 6.1 years, a time that was shortened to 1.4 years in the epoch of the first McDonald's criteria, and by a further reduction to 4 months for the third set of McDonald's criteria. During first year after onset only 20% of patients got a diagnosis in the Poser epoch, in comparison with 45% during the days of first McDonald and almost 90% when last McDonald revision was used.
Conclusions: There has been a dramatic shortening of time from MS onset to diagnosis in parallel with the adoption of new diagnostic criteria in Sweden, in recent decades. Although other mechanisms, such as improved MS care with a higher degree of diagnostic vigilance could contribute, diagnostic criteria should be taken into account in studies of longitudinal data when diagnosis date is used as a reference point in any epidemiological analysis of MS course.
Disclosure: LS and EH declare no conflicts of interest.
JH has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec, Merck, Novartis and Sanofi-Genzyme. This MS research was funded by the Swedish Research Council and the Swedish Brain foundation.

Abstract: 99

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis

L. Stawiarz1, E. Hagel2, J. Hillert1

1Department of Clinical Neuroscience (CNS), 2Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden

Background: The earlier multiple sclerosis (MS) diagnostic criteria of Schumacher and Poser were mostly based on clinical symptoms and signs. Improved insights into MS course and the inclusion of magnetic resonance imaging (MRI) to detect brain lesions, allowed an MS diagnosis to be made stepwise, earlier based on Barkhof-Tintoré's MRI criteria and leading to a series of new McDonald's criteria.
Objectives: To study the interval from first symptom of MS to the date of diagnosis in relation to the introduction of upgraded MS diagnostic criteria from conservative to more liberal ones.
Methods: We used data of 19,600 MS patients from the Swedish MS registry collected between 1996 and 2019. 92.5% had a registered date of onset and 85.1% a date of diagnosis. 62% of dates of onsets and diagnosis were registered prospectively whereas 38% were retrospectively collected from medical records or other previous data bases. Kaplan-Meier estimator and plots were applied. Survival probabilities were evaluated for 5 diagnosis epoch groups according to the diagnostic criteria advised at the time: 1965-1982 Schumacher, 1983-2000 Poser, 2001-2004 McDonald's first version, 2005-2009 revisions of 2005, 2010-2016 revisions of 2010 and 2017-2019 revisions of 2017. Time to failure was defined as time from onset to diagnosis with right censoring for deceased, migrated and other withdrawals from the registry.
Results: Relative to the time epoch, when Poser criteria were standard, time from MS onset to diagnosis decreased step-wise with the introduction on new diagnostic criteria. For instance, using Poser criteria, 50% of all the patients received a diagnosis within 6.1 years, a time that was shortened to 1.4 years in the epoch of the first McDonald's criteria, and by a further reduction to 4 months for the third set of McDonald's criteria. During first year after onset only 20% of patients got a diagnosis in the Poser epoch, in comparison with 45% during the days of first McDonald and almost 90% when last McDonald revision was used.
Conclusions: There has been a dramatic shortening of time from MS onset to diagnosis in parallel with the adoption of new diagnostic criteria in Sweden, in recent decades. Although other mechanisms, such as improved MS care with a higher degree of diagnostic vigilance could contribute, diagnostic criteria should be taken into account in studies of longitudinal data when diagnosis date is used as a reference point in any epidemiological analysis of MS course.
Disclosure: LS and EH declare no conflicts of interest.
JH has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from, BiogenIdec, Merck, Novartis and Sanofi-Genzyme. This MS research was funded by the Swedish Research Council and the Swedish Brain foundation.

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