Cleveland Clinic Expert Shares Updates to Global Diagnostic Criteria for Multiple Sclerosis Announced at 40th Congress of the European Committee for Treatment and Research of Multiple Sclerosis

According to the Atlas of Multiple Sclerosis, there are 2.9 million people worldwide living with multiple sclerosis (MS) – an autoimmune disease impacting the central nervous system.

MS can be challenging to diagnose due to its varied presentations and similarity to other neurological conditions. A Cleveland Clinic physician who specializes in MS says on average, it takes about two years from the onset of symptoms for an individual to receive a diagnosis, and misdiagnosis occurs in about 20% of cases.

“This delay in accurate diagnosis has negative implications as research shows that early use of a highly effective treatment reduces overall risk of disability and improves clinical outcomes,” said Daniel Ontaneda, M.D., Ph.D., a neurologist with Cleveland Clinic’s Mellen Center for Multiple Sclerosis Treatment and Research. “MS specialists want treatment to begin as soon as possible and are constantly looking for ways to improve our ability to diagnose early and accurately.”

MS is an autoimmune and neurodegenerative neurological disorder in which the immune system mistakenly attacks specific cells in the brain and spinal cord nerves, which causes damage that interrupts messages sent throughout the body to perform functions like vision, sensation and movement. As a result of this interruption, MS symptoms can include muscle weakness, vision changes, numbness and memory issues.

Evaluating clinical symptoms alongside imaging and other tests (imaging of the eye, spinal fluid analysis, electrical studies), to date, the McDonald criteria – the current gold standard for diagnosing MS – has limitations in its ability to render an accurate and timely diagnosis.

To make the diagnosis of MS more accurate and simpler, clinicians from around the world collaborated to revise the criteria and announced the latest iteration at the 40th Congress of the European Committee for Treatment and Research of Multiple Sclerosis in Copenhagen, Denmark.

“This is the first significant revision to the criteria since 2017 and includes a major shift toward increased sensitivity through the addition of pathologically specific biomarkers (tests which are highly sensitive and specific to the disease),” says Dr. Ontaneda who contributed to the criteria. “Essentially, the new criteria says that if certain conditions are present, we no longer have to wait for clinical symptoms to occur to confirm it is MS, effectively moving up the timeline for diagnosis.”

This update gives clinicians the ability to diagnose MS in asymptomatic individuals.

“This is a significant advancement and will change the way we treat MS,” said Dr. Ontaneda. “Previously, individuals who did not have symptoms but had white matter lesions present on their brain – a hallmark of MS – were diagnosed with radiologically-isolated syndrome, thought to be an early form of the disease, but typically did not start treatment. Now, because we can rely on additional features in the new criteria, we can diagnose these individuals with MS and begin treatment right away.”

The ability to diagnose asymptomatic individuals raises questions about the use of medications already approved for the treatment of MS and whether they can now be used in this patient population. While these individuals have not been studied across all the medications currently approved, regulators will have to make a decision on whether to now include them or not.

Dr. Ontaneda says it will take time to determine this potential change in treatment and for clinicians to adopt the criteria in clinical practice, but it is an important step forward in MS care.

There are more than 20 disease-modifying therapies approved to manage symptoms and slow disease progression, and this update will help those living with MS get access to them sooner.

These pharmacological treatments can be complemented by non-pharmacological interventions to further improve overall health and wellness in MS.

Dr. Ontaneda recommends these tips for living well with MS:

• Eat a Healthy and Balanced Diet: As an inflammatory autoimmune condition, eating a healthy diet can help to keep inflammation in check. A Mediterranean-style diet emphasizing heart-healthy and anti-inflammatory foods is recommended. Try to incorporate fruits and vegetables, whole grains and lean proteins and avoid red meat, as well as food that is processed and high in saturated fats, refined sugars and salt.
• Exercise: Exercise is considered safe and has been shown to improve quality of life in those living with MS, including both physical and emotional health. A combination of aerobic activity and stretching can help manage many of the symptoms associated with MS, such as fatigue, and improve stamina. Healthy adults living with MS and no physical disability should engage in 150 minutes of moderate level of activity each week.
• Mental Health: Psychological conditions including depression, anxiety and stress are common in those living with MS and can have a major impact on quality of life as well as worsen symptoms. However, there are ways to combat them. Meditation, guided imagery and mindfulness can all help reduce stress, while physical therapy, yoga, and tai chi can improve anxiety, depression and fatigue. These mind-body processes can be beneficial when balancing emotional health and wellness.