What are the diagnostic criteria for multiple sclerosis (MS)?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Current diagnostic criteria for MS include clinical and paraclinical measures. To render the diagnosis of MS, due diligence is necessary to exclude alternative diagnoses. The revised McDonald criteria [5] rely on the principle that an attack is a neurological disturbance consistent with the diagnosis of MS persisting for 24 hours or more in the absence of fever or infection. [5] In order to meet the criterion of dissemination in time, 30 days or more is required between events of neurological disturbance. Dissemination in space requires that the second event occurs in a different anatomic location than the first. [5]

Using the 2010 McDonald criteria revision [5] (see Table 1), the diagnosis of MS can be confirmed at the time of initial presentation, since the baseline MRI scan may be used to demonstrate both dissemination in space and time with respect to lesions of the brain and spinal cord.

Table 1. Summary of the Revised McDonald Criteria Used for the Diagnosis of Multiple Sclerosis (Open Table in a new window)

Number of Clinical Attacks

Lesions

Additional Criteria Required

≥2

Objective clinical evidence of ≥2 lesions OR a single lesion with historical evidence of prior lesion

None

≥2

Objective clinical evidence of 1 lesion

DIS: ≥1 T2 MRI lesion in ≥2 typical* CNS regions OR the occurrence of another clinical attack

1

Objective clinical evidence of ≥2 lesions

DIT: Simultaneous asymptomatic gadolinium-enhancing and non-enhancing lesions OR a new T2 and/or gadolinium-enhancing lesion on follow-up MRI OR the occurrence of a second clinical attack

1

Objective clinical evidence of a single lesion

DIS: ≥1 MRI T2 lesion in ≥2 typical* CNS regions OR await further clinical attack(s)

AND

DIT: Defined as simultaneous asymptomatic gadolinium-enhancing and non-enhancing lesions OR a new T2 and/or gadolinium-enhancing lesion on follow up MRI OR the occurrence of a second clinical attack

*Two of the following four T2 lesions: periventricular, juxtacortical, infratentorial, and spinal cord.


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