Criteria
Optic neuritis (ON) criteria
Diagnosis of idiopathic ON is clinical and there are no established diagnostic criteria, except for criteria developed as part of the International Classification of Headaches, which are not thought to be adequate or sufficiently inclusive for ON. However, the Optic Neuritis Treatment Trial (ONTT) inclusion criteria comprised unilateral acute or sub-acute loss of vision in patients aged 18-46 years old. The presence of a relative afferent papillary defect (RAPD) was required for inclusion.[20] Systemic illnesses such as SLE or sarcoidosis had to be ruled out.
Multiple sclerosis (MS): Poser 1983 and McDonald (International Panel) criteria 2001, 2005, 2010, and 2017
ON may be part of MS. The MS diagnostic criteria have been established by a panel of experts led by Poser in 1983 and by another international panel in 2001; revised in 2005, 2010, and 2017.[27][38][39][40][41] The basic principle of all these sets of criteria is the need for dissemination of demyelination in time and space. The McDonald criteria take into account developments in MRI that allow evidence for dissemination to be derived from MRI. The last set of criteria include cerebrospinal fluid analysis in the diagnosis algorithm, with positive oligoclonal bands representing proof of dissemination in time.[27]
Wingerchuk criteria for neuromyelitis optica (NMO), 1999; revised 2006; re-established as new set of criteria 2015
ON is a defining part of neuromyelitis optica (NMO). The revised NMO criteria are: 1) ON; 2) transverse myelitis; 3) at least 2 of the following: MRI evidence of cord lesion spanning 3 vertebral segments or more; MRI of the brain not diagnostic of MS; and/or aquaporin-4 (AQP4) antibody positivity.[42] MRI criteria distinguishing NMO from MS have been published.[43] In 2015, the International Panel for Neuromyelitis Optica Diagnosis (IPND) put together a new set of consensus criteria.[44] The condition is now called NMO spectrum disorder (NMOSD), and two clinical scenarios are identified: NMOSD with AQP4-IgG, which requires at least one core clinical characteristic, positive AQP4-IgG, and exclusion of other diagnoses; and NMOSD without AQP4-IgG or unknown AQP4- IgG status, which requires at least two chore characteristics resulting from ≥ 1 clinical attacks and satisfying certain supporting MRI requirements plus at least one of ON, longitudinally extensive transverse myelitis, or area postrema syndrome; AQP4-IgG negative or unknown; and exclusion of other diagnoses. The core characteristics are: ON, acute myelitis, and area postrema syndrome.
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