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Currently, the diagnosis of multiple sclerosis (MS) relies on the 2 foundational pillars of dissemination in space and time for inflammatory demyelinating lesions after an initial demyelinating clinical event. The last revisions of the MS McDonald diagnostic criteria, published in 2017, specified the requirement of at least 1 lesion in 2 of 4 CNS regions (periventricular, juxtacortical/cortical, infratentorial, spinal) to satisfy dissemination in space (DIS).1 While an international panel had previously recommended the optic nerve as an additional region to support DIS,2 given the lack of evidence then, it was not included in the 2017 McDonald criteria.1 However, 25% of patients with MS present with optic neuritis (ON), and asymptomatic optic nerve demyelination is detectable in up to half of patients with MS.3-5 In addition, disease-modifying treatments, initiated after ON as the initial manifestation of MS, delay long-term disability progression.6 Despite these considerations, infratentorial and spinal presentations effectively convey greater influence than optic nerve involvement in the MS diagnostic process.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 340
- Received April 27, 2023.
- Accepted in final form May 23, 2023.
- © 2023 American Academy of Neurology
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