2023 American Academy of Neurology Abstract Website

Gabriel Bsteh¹, Harald Hegen², Patrick Altmann⁴, Michael Auer³, Klaus Berek³, Franziska Di Pauli², Barbara Kornek⁵, Nik Krajnc⁴, Fritz Leutmezer⁴, Stefan Macher⁴, Paulus Rommer⁴, Karin Zebenholzer⁴, Gudrun Zulehner⁴, Tobias Zrzavy⁴, Florian Deisenhammer², Berthold Pemp⁴, Thomas Berger⁵
¹Medical University Vienna, Department of Neurology, ²Medical University of Innsbruck, ³Neurology, Medical University of Innsbruck, ⁴Medical University of Vienna, ⁵Neurology, Medical University of Vienna

Objective:

To investigate the effect of adding the optic nerve region as determined by OCT as part of the DIS criteria to improve the 2017 diagnostic criteria.

Background:

The optic nerve has been recommended as an additional region for demonstrating dissemination in space (DIS) in diagnostic criteria for multiple sclerosis (MS).

Design/Methods:

From a prospective observational study, we included patients with a first demyelinating event who had complete information to assess DIS and a spectral-domain OCT scan obtained within 90 days. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions based on validated thresholds for OCT inter-eye differences. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 3 years of follow-up were selected to assess the diagnostic performance. Subgroup analyses were performed distinguishing ON vs. non-ON at first demyelinating event.

Results:

We analyzed 231 MS patients (mean age 30.3 years [SD 8.1], 74% female) during a median observation period of 61 months (range: 12 - 93).

Adding the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS.

Conclusions:

Addition of the optic nerve, assessed by OCT, as a fifth region in the current DIS criteria moderately improves diagnostic performance by increasing sensitivity without lowering specificity.