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

Updated: Aug 07, 2018
  • Author: Djamil Fertikh, MD; Chief Editor: James G Smirniotopoulos, MD  more...
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Answer

Answer

Imaging plays an important role in MS, as noted in the McDonald Criteria (see Table 1). It is important to note that the McDonald Criteria were largely collected from adult white European and North American populations. MRI is used to demonstrate lesion dissemination in time (DIT) and space (DIS). [13, 14, 15, 16]

 

Table 1. McDonald Criteria, Revised 2017 (Open Table in a new window)

  Number of lesions with       objective clinical evidence Additional data needed for a diagnosis of MS
≥2 clinical attacks ≥2 none
≥2 clinical attacks

≥1 (as well as clear-cut historical evidence of 

a previous attack involving a lesion in a distinct anatomic location)

none
≥2 clinical attacks 1 Dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI
1 clinical attack ≥2 Dissemination in time demonstrated by an additional clinical attack or by MRI OR demonstration of CSF-specific oligoclonal bands
1 clinical attack 1 Dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI AND dissemination in time demonstrated by an additional clinical attack or by MRI OR demonstration of CSF-specific oligoclonal bands.

 

If the 2017 McDonald Criteria are fulfilled and there is no better explanation for the clinical presentation, the diagnosis is multiple sclerosis. If multiple sclerosis is suspected by virtue of a clinically isolated syndrome but the 2017 McDonald Criteria are not completely met, the diagnosis is possible multiple sclerosis. If another diagnosis arises during the evaluation that better explains the clinical presentation, the diagnosis is not multiple sclerosis. 

Other key changes to the McDonald Criteria include the following:

  • Brain stem and cord lesions can now be counted among the 2 lesions disseminated in space and time.
  • CSF oligoclonal bands can now be used to substitute for demonstration of dissemination in time in some settings.
  • Both asymptomatic and now symptomatic MRI lesions can be considered in determining dissemination in space (optic nerve lesions are still excluded).
  • Cortical lesions have been added to juxtacortical lesions as determinant for dissemination in space.

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