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    Patent Pending

    McDonald Criteria for Multiple Sclerosis (2017 Revision)

    Diagnoses multiple sclerosis.
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    INSTRUCTIONS

    Changes from the 2010 McDonald Criteria:

    1. Presence of CSF-specific oligoclonal bands may now substitute for dissemination in time (DIT) even if baseline MRI findings do not meet DIT criteria.

    2. In patients with brainstem or spinal cord attacks, symptomatic lesions may now be included as MRI evidence of dissemination in space (DIS) or DIT.

    3. Cortical lesions may now fulfill MRI criteria for DIS (in addition to juxtacortical lesions).

    When to Use
    Pearls/Pitfalls

    Patients with suspected MS who have undergone MRI.

    • Developed for patients with a typical clinically isolated syndrome deemed unlikely to have other diagnoses, NOT to differentiate MS from other conditions.
    • These criteria may help differentiate relapsing-remitting MS from other clinically isolated syndromes that may mimic it.
    Clinical attacks

    Must have ≥1 clinical attack

    ≥2
    1
    Lesions

    Must have ≥1 lesion

    ≥2
    1

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Threshold for additional testing (i.e., spinal cord MRI or CSF examination) should be low, according to the international panel that developed these criteria.

    Formula

    McDonald Criteria (2017):

    Clinical attacks*

    Number of lesions with objective clinical evidence**

    Additional data needed for diagnosis of MS

    ≥2

    ≥2

    No additional tests required to demonstrate dissemination in space and time

    1 (as well as clear-cut historical evidence of a previous attack involving a lesion in a distinct anatomical location)

    No additional tests required to demonstrate dissemination in space and time

    1

    Dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI

    1

    ≥2

    Dissemination in time demonstrated by additional clinical attack or MRI, or presence of CSF-specific oligoclonal bands

    1

    Dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI and dissemination in time demonstrated by additional clinical attack or MRI, or presence of CSF-specific oligoclonal bands

    *“Clinical attack” = monophasic clinical episode with patient-reported symptoms and objective findings reflecting inflammatory demyelinating CNS event (focal or multifocal), subacute or acute, for ≥24 hrs, with or without recovery, and no fever or infection present. Attack, relapse, exacerbation, and clinically isolated syndrome (first episode) are all synonymous.

    **“Objective clinical evidence” = abnormality on neurologic exam, imaging (MRI or optical coherence tomography), or visual evoked potentials, corresponding to anatomical location suggested by symptoms.

    Dr. Alan J. Thompson

    About the Creator

    Alan J. Thompson, MD, FMedSci, FRCP, FRCPI, is the dean of the Faculty of Brain Sciences and the Garfield Weston Professor of Clinical Neurology and Neurorehabilitation at the University College London in London, England. He is also a senior investigator and faculty member at the National Institute for Health Research. Dr. Thompson’s primary research is focused on predicting outcomes in multiple sclerosis using MRI techniques.

    To view Dr. Alan J. Thompson's publications, visit PubMed