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Revised McDonald Criteria for Multiple Sclerosis Diagnosis (2010)
Diagnoses MS from clinical attacks and MRI-defined dissemination in space and time.
Revised McDonald Criteria for Multiple Sclerosis Diagnosis (2010)
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, juxtacortical, infratentorial, spinal cord; symptomatic lesions excluded in brainstem/spinal cord syndromes), or a clinical attack implicating a different CNS site.
Dissemination in time (DIT) demonstrated
MRI: simultaneous asymptomatic gadolinium-enhancing and non-enhancing lesions on any single scan, or a new T2 lesion on follow-up MRI referenced to a baseline scan (irrespective of timing); OR a second clinical attack. CSF-specific oligoclonal bands cannot substitute for DIT under the 2010 criteria.
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
- Historical/legacy diagnosis of MS per the 2010 revision, prior to the 2017 update.
Formula
MS is diagnosed when dissemination in space (DIS) and dissemination in time (DIT) are demonstrated clinically or by MRI; PPMS requires 1 year of progression plus 2 of 3 supportive criteria (brain DIS, spinal cord DIS, CSF-specific oligoclonal bands).
Pearls and pitfalls
- Superseded by the 2017 revision, which added CSF-oligoclonal-band substitution for DIT and expanded which lesions count toward DIS.