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McDonald Criteria for Multiple Sclerosis (2017 Revision)
Diagnoses multiple sclerosis from clinical attacks, MRI dissemination, and CSF findings.
McDonald Criteria for Multiple Sclerosis (2017 Revision)
Clinical attacks
Objective clinical evidence of lesion(s) (if >=1 attack)
Dissemination in space (DIS) demonstrated
MRI: >=1 T2 lesion in >=2 of 4 typical CNS regions (periventricular, cortical/juxtacortical, infratentorial, spinal cord - symptomatic lesions may count), or a clinical attack implicating a different CNS site.
Dissemination in time (DIT) demonstrated
MRI: simultaneous asymptomatic gadolinium-enhancing and non-enhancing lesions at any time, or a new T2/enhancing lesion on follow-up MRI; OR a second clinical attack; OR presence of CSF-specific oligoclonal bands (in a patient who fulfills DIS but not yet DIT).
PPMS pathway only: >=1 year of disability progression independent of relapse
PPMS pathway only: number of supportive criteria met (of 3)
of 3
ResultMS diagnosed
>=2 attacks with objective clinical evidence of >=2 lesions fulfills DIS and DIT clinically; no further evidence required.
When to use
- Diagnosing multiple sclerosis in a patient with a typical clinically isolated or progressive syndrome, after excluding alternative diagnoses.
Formula
MS is diagnosed when dissemination in space (DIS) and dissemination in time (DIT) are demonstrated clinically, by MRI, or (for DIT only) substituted by CSF-specific oligoclonal bands; PPMS requires 1 year of progression plus 2 of 3 supportive criteria.
Pearls and pitfalls
- The 2017 revision is the first to allow CSF-specific oligoclonal bands to substitute for DIT.
- Cortical (not just juxtacortical) lesions and symptomatic lesions in brainstem/spinal cord syndromes may now count toward DIS.
- Always requires 'no better explanation' for the clinical presentation.