Revised McDonald Criteria for Multiple Sclerosis Diagnosis

2017 Revised McDonald Criteria for MS
Number of Clinical Attacks
Objective Clinical Lesions
Dissemination in Space (DIS)
Dissemination in Time (DIT)
CSF Oligoclonal Bands
Result: –
Awaiting input
Select all 5 criteria.
Determines presence of MS using MRI findings.

Formula

The Revised McDonald Criteria also includes diagnosis of Primary progressive multiple sclerosis (PPMS). Positive if: ≥1 year of disease progression (this can be determined either prospectively or retrospectively) Plus two of the following three criteria Brain dissemination in space ( ≥1 T2 bright lesions in ≥1 of juxtacortical, periventricular, infratentorial areas) Spinal cord dissemination in space (≥2 T2 bright lesions) Positive CSF (oligoclonal bands and/or elevated IgG index)

Pearls / Pitfalls

The 2010 Revised McDonald Criteria is seen as the gold standard of MS diagnosis, and uses MRI data to aid in diagnosis.

Management

The 2010 McDonald Criteria for Diagnosis of MS Clinical Presentation Additional Data Needed for MS Diagnosis ∙Two or more attacks ∙Objective clinical evidence of 2 or more lesions with reasonable historical evidence of a prior attack None; clinical evidence will suffice Additional evidence (eg, brain MRI) desirable, but must be consistent with MS ∙Two or more attacks ∙Objective clinical evidence of 1 lesion Dissemination in space demonstrated by MRI OR Await further clinical attack implicating a different site ∙One attack ∙Objective clinical evidence of 2 or more lesions Dissemination in time demonstrated by MRI OR second clinical attack ∙One attack ∙Objective clinical evidence of 1 lesion (clinically isolated syndrome) Dissemination in space demonstrated by MRI OR Await a second clinical attack implicating a different CNS site AND Dissemination in time, demonstrated by MRI or second clinical attack ∙Insidious neurologic progression suggestive of MS One year of disease progression and dissemination in space AND One or more T2 lesions in brain, in regions characteristic of MS AND Two or more T2 focal lesions in spinal cord Positive CSF Notes: An attack is defined as a neurologic disturbance of the kind seen in MS. It can be documented by subjective report or by objective observation, but it must last for at least 24 hours. Pseudoattacks and single paroxysmal episodes must be excluded. To be considered separate attacks, at least 30 days must elapse between onset of one event and onset of another event.

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