Identification of demyelinating lesions and application of McDonald criteria when confronted with white matter lesions on brain MRI.

INTRODUCTION: White matter lesions (WML) on magnetic resonance imaging (MRI) are common in clinical practice. When analyzing WML, radiologists sometimes propose a pathophysiological mechanism to explain the observed MRI abnormalities, which can be a source of anxiety for patients. In some cases, discordance may appear between the patient's clinical symptoms and the identification of the MRI-appearing WML, leading to extensive diagnostic work-up. To avoid misdiagnosis, the analysis of WML should be standardized, and a consensual MRI reading approach is needed. OBJECTIVE: To analyze the MRI WML identification process, associated diagnosis approach, and misinterpretations in physicians involved in WML routine practice. METHODS: Through a survey distributed online to practitioners involved in WML diagnostic work-up, we described the leading causes of MRI expertise misdiagnosis and associated factors: clinical experience, physicians' subspecialty and location of practice, and type of device used to complete the survey. The survey consisted of sixteen T2-weighted images MRI analysis, from which ten were guided (binary response to lesion location identification), four were not shown (multiple possible answers), and two were associated with dissemination in space (DIS) McDonald criteria application. Two independent, experienced practitioners determined the correct answers before the participants' completion. RESULTS: In total, 364 participants from the French Neuro Radiological (SFNR), French Neurological (SFN), and French Multiple Sclerosis (SFSEP) societies completed the survey entirely. According to lesion identification, 34.3% and 16.9% of the participants correctly identified juxtacortical and periventricular lesions, respectively, whereas 56.3% correctly identified non-guided lesions. Application of the 2017 McDonald's DIS criteria was correct for 35.3% of the participants. According to the global survey scoring, factors independently associated with correct answers in multivariate analysis were MS-expert subspecialty (P<0.001), young clinical practitioners (P=0.02), and the use of a computer instead of a smartphone to perform WML analysis (P=0.03). CONCLUSION: Our results highlight the difficulties regarding WML analysis in clinical practice and suggest that radiologists and neurologists should rely on each other to ensure the diagnosis of multiple sclerosis and related disorders and limit misdiagnoses.

What to keep? What to discard? Virtual or in-person learning after the pandemic: Expectations of French neurology residents.

ISSUE: To define the relevance of online courses for neurology residents in a post-COVID environment and how to improve existing programs. EVIDENCE: In total, 99 French neurology residents voluntarily chose to participate in this survey. They were asked about the proportion of online courses they followed before and during the pandemic, the advantages and inconveniences of each format, the type of environment in which they attended online classes, and their preference for either online or in-person learning. Out of the 99 French neurology residents who responded, 65% of them had less than 25% of their course load online before the pandemic, whereas in 2022, 38% of them had more than 75% of their courses in a virtual format. With 56% of students being able to attend online classes from home and another 25% attending from their hospital unit, general access was not an issue. However, only 18% of residents reported that these online courses increased their attendance and 74% of them reported preferring in-person courses to those online. To improve the current offer of online courses, residents suggested a more interactive learning method, such as through clinical cases (49%). IMPLICATIONS: Although a small portion of students is satisfied with this change toward online learning, most residents seek to go back to in-person courses and conferences. Virtual programs did not increase student attendance and instead highlighted the lack of dedicated time available for specialized education during neurology residency. Returning to in-person training and education could improve residents' focus and help develop a network of health professionals across the country.

Genetics and familial distribution of multiple sclerosis: A review.

PURPOSE OF REVIEW: This article reviews the genetics of multiple sclerosis (MS), as well as intra-familial concordance and clinical correlations between different members of a family. Indeed, significant findings have been made on these topics in recent years. RECENT FINDINGS: The influence of specific genes on the clinical or radiological presentation of MS has been described as well as preliminary findings in the field of pharmacogenomics. Within familial forms of MS, correlations on specific aspects of the disease have been described, such as the age of onset or the clinical course between siblings. SUMMARY: The genetic contribution to the risk of developing MS is now estimated to be about 50%, with the genes involved mainly located within the major histocompatibility complex. Familial MS represents 12.6% of all MS cases, with the risk depending on the degree of genetic proximity to the index case. Furthermore, these familial cases seem to have a different clinical presentation from sporadic cases such as earlier worsening of disability and more severe long-term disability. Clinical correlations between different members of a family with MS have also been described, such as a similar age of onset between siblings, but deep clinical and radiological phenotyping is warranted to investigate MS disease severity concordance within familial cases of MS.