Specificity of Barkhof Criteria in Predicting Conversion to Multiple Sclerosis When Applied to Clinically Isolated Brainstem Syndromes

Background 

Barkhof criteria have been adopted to demonstratedissemination in space in the new multiple sclerosis diagnosticcriteria because of their high specificity for predicting conversionto multiple sclerosis. One of the 4 Barkhof criteria is thepresence of an infratentorial lesion.  In clinically isolatedsyndromes (CIS) of the brainstem (CISB), the infratentorialcriterion does not demonstrate dissemination in space, raisingthe possibility that the criteria may be less specific in CISB,as compared with specificity in other CIS, in which all 4 criteriademonstrate dissemination in space.

Objective 

To compare the validity indices of Barkhof criteriain CISB with those in other CIS.

Design 

Inception cohort with median follow-up of 34 monthsfor CISB and 40 months for other CIS.

Setting 

 Institutional ambulatory referral center.

Patients 

A sample of 51 patients with CISB and 102 patientswith other CIS (46 with myelitis and 56 with optic neuritis)was analyzed. Barkhof criteria, with a cutoff of 3 of 4, wereapplied to magnetic resonance imaging performed at baseline.  Four combinations each containing 3 parameters were also applied,with a cutoff of 2 of 3.

Main Outcome Measure 

Specificity of unmodified Barkhofcriteria and of the 4 combinations to predict conversion toclinically definite multiple sclerosis.

Results 

The specificity of the criteria in CISB was 61%against 73% in other CIS. The combinations that retained theinfratentorial lesion parameter had lower specificities in theCISB group; in analysis of the group with other CIS, no suchdifferences were found.

Conclusion 

The infratentorial lesion criterion is responsiblefor the lower specificity of Barkhof criteria in CISB.

From the

­      Unitats de Neuroimmunologia Clínica (Drs Sastre-Garriga, Tintoré, Nos, Río, and Montalban) and

­      Ressonància Magnètica (Dr Rovira),

­      Hospital Universitari Vall d'Hebron,

­      Barcelona, Spain;

­      Institute of Neurology,

­      London, England (Dr Thompson).

­      Jaume Sastre-Garriga, MD;

­      Mar Tintoré, MD, PhD;

­      Alex Rovira, MD, PhD;

­      Carlos Nos, MD; Jordi Río, MD, PhD;

­      Alan J. Thompson, MD; Xavier Montalban, MD, PhD

Arch Neurol. 2004;61:222-224.