Anyone familiar with Swanton criteria vs McDonald criteria?

[jenandherboys]

Quix-or anyone else who may be reading medical journals...I just finished reading about a newer criteria being proposed for interpreting MRI results(proposed in 2006) in regards to fulfilling dissemination in space(DIS) requirement for  diagnosis following occurance of CIS.  

The Swanton require "at least 1 T2 lesion in at least two of four locations defined as characteristic of MS: periventricular, juxtacortical, infratentorial and spinal cord" in order to demonstrate DIS.  "Dissemination in time(DIT) was achieved by a new T2 lesion on a follow-upscan irrespective of the timing of a baseline scan."

According to the paper, "initial studies have suggested that these new criteria were more sensitive than previous criteria, without compromising specificity and accuracy."  The  conclusion is that, compared to Barkhoff-Tintore's criteria(currently used to evaluate MRI images as part of the McDonald diagnostic criteria), "Swanton's criteria are simpler and more sensitive, with a slight decrease in specificity. These results reiforce their use in multiple sclerosis diagnosis."

Anyway, just looking for any thoughts or comments.  I am considering presenting this info to my neurologist for his input.  It also helps that when this criteria is applied to the three lesions on my brain MRI, I think it qualify me in the DIS category.

If anyone is interested I can provide info regarding the exact article I found.

Thanks and be well!

Jen

[Quixotic1]

There have been several attempts to simplify the McDonald Criteria.  This is a good one.  Now there has to be sufficient studies to validate its sensitivity and specificity and then it would have to be adopted by a recognized panel.

Remember that the McD Criteria were developed to diagnose MS BEFORE the person had had sufficient attacks or variety of lesions to make the diagnosis.  Thus, it was NEVER meant to describe the way MS is diagnosed, just to let the MRI "substitute" when there wasn't enough clinical (history and physical exam) data to show spread of the disease both in time and space.

MS can still be diagnosed easily with 2 or more attacks, 2 or more clinical lesions, a thorough rule out of the Mimics, and an abnormal MRI (Two or more consistent lesions.)  This whole business of requiring the MRI to show specific things in specific numbers in specific locations NO MATTER WHAT the clinical picture shows is all BOGUS.  It shows that the neurologist does not understand the intent or use of the McDonald Criteria.

I think the Swanton Criteria look great, but it takes a lot to move a whole profession.  Remember a huge number of neuros still think that there is no pain in MS and that it never occurs over age 50 or that it cannot occur without blindness!!

I still quake with fear when it looks like anyone is trying to turn MS into an MRI diagnosis.  This would benefit no one except the lazy neuros who prefer to sit around with their thumbs up their arses.

Q

[jenandherboys]

Alex-

Good point about how to phrase my query...I've run into too may DR's whose egos prevent them from really listening to anything I say when I start "discussing" anything contrary to their textbook answers or outside of their comfort zone.

Thanks again for your reply!  Stay well!

Jen

[HVAC]

From what I read it probably will take over the McDonald Criteria. It depends on your Neurologist how and if you bring it up. If you make him defensive it may not be a good thing. I might phrase it as a curious question.

Alex