Multiple sclerosis (MS) may not be the most prevalent of the diagnoses that we treat, and its place as the “most common disabling neurological disease of young adults”1 is dubious (migraine is far more common and chronic daily headache affects 3 to 5% of the US population), yet the asymptotic pace of MS research has forced all neurologists to pay close attention to the world of MS. Starting with this issue of Practical Neurology, we will bring to you digestible (and palatable) summaries of the most important moments in MS throughout the year.
First, let’s look back at the year that’s passed. Throughout 2017, you may have heard or read teasers about planned revisions to the McDonald criteria, and these illusive criteria were finally published (in the nick of time before the end of 2017) in Lancet Neurology online on December 21, 2017.2 The 2017 McDonald criteria for the diagnosis of MS was the product of a 30-person international panel that first met in Philadelphia in 2016, and will eventually become the criteria used in clinical trials for new disease-modifying therapies (DMTs) for MS (although there may be considerable lag time–even the recently and only FDA approved MS DMT for primary-progressive MS3 used the 2005 McDonald criteria4). Although there are no earth-shattering updates that will change the way you think about MS, there has been some confusion about the role of cerebrospinal fluid (CSF) in the revised criteria. In the 2017 revisions to the McDonald criteria, CSF is still not required for the diagnosis of MS, but it can be used to diagnose MS even earlier by fulfilling the need for dissemination in time (but not space) and substituting for a clinical relapse. It is important to note that negative CSF results do not rule out MS, and research has shown that the further you get from the equator, the less likely CSF will be positive in people with MS.5 To help educate the community further about how CSF may be important, but not necessary, in the diagnosis of MS, I interviewed Dr. Pat Coyle, Professor and Vice Chair of the Stony Brook University Department of Neurology during the recent joint ECTRIMS (European Committee for Treatment and Research in MS)–ACTRIMS (Americas Committee for Treatment and Research in MS) conference in Paris in late October 2017.6
We concluded 2017 with 13 separate branded DMTs, one branded generic, and two unbranded generic DMTs for the proactive treatment of MS, and it is important for us to recognize how far we have come in what was an untreatable disease (with no FDA-approved products) as recently as 1992. Although neurologists have done an excellent job in conducting rigorous randomized controlled trials, we have (until recently) faltered in the US in producing real-world evidence through a national, prospective MS registry. On October 20, 2017, the National Multiple Sclerosis Society and Corrona LLC announced their collaboration in the launch of the Corrona MS Registry,7 which has already recruited 100 patients in three months. Corrona’s collaboration with the National MS Society builds upon its 17 years of experience in conducting the largest registry of patients with rheumatoid arthritis (over 45,000 patients have entered the registry) and the successful ongoing collaboration for its psoriasis registry with dermatologists and the National Psoriasis Foundation.
Throughout 2018, we look forward to your feedback as MS Minute highlights important research, advocacy, and events in the world of MS.
Got a minute for MS? @KantorNeurology
1. Rolak LA. Multiple sclerosis: it’s not the disease you thought it was. Clinical Medicine & Research. 2003;1:57-60.
2. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria Lancet Neurol. Available online 21 December 2017.
3. Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med. 2017;376(3):209-20.
4. Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria.”Ann Neurol. 2005; 58: 840-6.
5. Dobson R, Ramagopalan S, Davis A, et al. Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude. J Neurol Neurosurg Psychiatry. 2013;84:909-914.
6. https://msworld.org/conference-center/?content=the-mcdonald-criteria-and-spinal-fluid. Accessed January 3, 2018.
7. Corrona Partners with National MS Society on Registry to Assess Safety and Efficacy of Therapies. http://practicalneurology.com/news/?id=49459¢er=36. Accessed January 3, 2018.
Daniel Kantor, MD, FAAN, FANA
President Emeritus of the Florida Society of Neurology
Founding President of the Medical Partnership 4 MS (MP4MS)
Director of Neurology at Florida Atlantic University
Boca Raton, Florida