MDCalc

Revised McDonald Criteria for Multiple Sclerosis Diagnosis

Determines presence of MS using MRI findings.

Primary Criteria

Per Polman, et. al, 2010: “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.”
Per Polman, et. al, 2010: “Clinical diagnosis based on objective clinical findings for 2 attacks is most secure. Reasonable historical evidence for 1 past attack, in the absence of documented objective neurological findings, can include historical events with symptoms and evolution characteristics for prior inflammatory demyelinating even; at least 1 attack however must be supported by objective findings.”

Diagnostic Result

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Management

The 2010 McDonald Criteria for Diagnosis of MS

Clinical PresentationAdditional 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 MSOne 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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