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A to Z of MS

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A to Z of MS McDonald criteria

The McDonald criteria for diagnosing multiple sclerosis were published in 2001 and revised in 2005 and 2010. In common with all MS diagnostic criteria, they seek to establish evidence of damage to the central nervous system that is disseminated in time (evidence of episode of damage in the central nervous system at different dates) and disseminated in space (evidence of damage to at least two different parts of the central nervous system).

The McDonald criteria use MRI evidence extensively to confirm an MS diagnosis, together with lumbar puncture evidence in some instances. They allow for an MS diagnosis to be made on the basis of one relapse, given the right MRI evidence.

The criteria specify that an attack or relapse must last for at least 24 hours, must be a neurological disturbance typical of multiple sclerosis, and that there must be at least 30 days between the onset of the first attacks and any subsequent attack - whether seen clinically or just on MRI - to count as two separate MS events.

Currently, people with MS may be diagnosed using these criteria.

Clinical presentation
(person presenting to neurologist)		 Additional data needed for MS diagnosis
Two or more attacks; objective clinical evidence of two or more lesions None
Two or more attacks; objective clinical evidence of one lesion Dissemination in space shown on MRI
or
Up to two MRI detected lesions typical of MS plus positive cerebrospinal fluid*
or
Await a further relapse suggestive of dissemination in space (ie affecting another part of the body)
One attack; objective clinical evidence of two or more lesions Dissemination in time demonstrated by MRI
or
Second clinical attack (relapse)
One attack; objective clinical evidence of one lesion (known as 'clinically isolated syndrome') Dissemination in space demonstrated by MRI
or
Up to two MRI detected lesions typical of MS plus positive cerebrospinal fluid* AND dissemination in time demonstrated by MRI
or
Dissemination in time demonstrated by MRI (ie new lesion seen on MRI at least 3 months after the original scan)
or
Second clinical attack (relapse)
Insidious neurological progression suggestive of multiple sclerosis (typical for primary progressive MS) Positive cerebrospinal fluid* AND dissemination in space, shown on MRI or
Abnormal visual evoked potential plus abnormal MRI AND dissemination in time demonstrated by MRI or
Continued progression for one year (determined retrospectively or by ongoing observation)

* 'positive cerebrospinal fluid' means positive tests on fluid drawn off by lumbar puncture

Adapted from: Compston A, et al. McAlpine's Multiple Sclerosis. 4th ed. 2006.

Reference

Polman CH,et al.
Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria.
Annals of Neurology 2011;69(2):292-302.
abstract

Polman CH, et al.
Diagnostic criteria for multiple sclerosis: 2005 revisions to the 'McDonald Criteria'.
Annals of Neurology 2005;58:840-846.
abstract

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