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A guide to guidelines
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

https://doi.org/10.1136/practneurol-2018-001945

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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 al1 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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    Footnotes

    • Contributors FDA and SAT were involved in the conception and design of the article, drafting, revision and final approval of the manuscript for publication. WJB and DTC were involved in the conception and revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. DTC and SAT are supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

    • Competing interests WJB reports personal fees from Roche and personal fees from Merck Serono, outside the submitted work. DTC has received, within the last 2 years, honoraria (paid to his employer) from Excemed for faculty-led education work, and meeting expenses from Novartis and Société des Neurosciences, outside the submitted work. SAT reports a personal fee from Roche, a personal fee and non-financial support from Novartis, a personal fee from Merck Serono, personal fees and non-financial support from Teva, and non-financial support from Biogen, all outside the submitted work.

    • Patient consent Obtained.

    • Provenance and peer review Commissioned; externally peer reviewed by Alasdair Coles, Cambridge, UK.

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