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New MS diagnostic criteria in practice
  1. Floriana De Angelis1,
  2. Wallace J Brownlee1,2,
  3. Declan T Chard1,2,
  4. S Anand Trip1,2
  1. 1 Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
  2. 2 National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK
  1. Correspondence to Dr S Anand Trip, National Hospital for Neurology & Neurosurgery, UCLH NHS Foundation Trust, London WC1N 3BG, UK; anand.trip{at}nhs.net

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Background

The diagnostic criteria for multiple sclerosis (MS), first developed in the 1950s, have since undergone several revisions, all focused on three main requirements for a diagnosis of MS:

  1. Objective clinical evidence of central nervous system (CNS) involvement.

  2. Evidence of lesions disseminated in time and space.

  3. Exclusion of other conditions that could better explain the clinical and paraclinical findings.

Before the widespread use of MR imaging, the criteria for dissemination in time and space were fulfilled by two attacks involving different parts of the CNS and clinical evidence of two lesions separated in time, or one attack with additional paraclinical evidence of another lesion. In 2001, McDonald et al 1 fully integrated the use of MR imaging into the diagnostic schema as an alternative to clinical evidence for dissemination in time and space, allowing an earlier diagnosis of MS. The McDonald criteria were revised in 2005, 2010 and 2017, building on new evidence for the role of MR imaging.2–4 The increasing focus on the importance of early treatment of MS with disease-modifying therapies has meant that a prompt and accurate diagnosis of MS has never been more important.

Previous diagnostic criteria

The 2010 revisions to the McDonald criteria simplified the requirements for dissemination in time and space on MRI and removed neurophysiological and cerebrospinal fluid (CSF) testing from the diagnostic criteria (for relapsing–remitting MS). Dissemination in space on MRI required at least one T2 lesion in at least two of four locations characteristic of MS (periventricular, juxtacortical, infratentorial and spinal cord), …

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