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McDonald Diagnostic Criteria for Multiple Sclerosis (MS)

What Is An Attack?

  • Neurological disturbance of kind seen in MS
  • Subjective report or objective observation
  • 24 hours duration, minimum
  • Excludes pseudoattacks, single paroxysmal episodes

Determining Time Between Attacks

  • 30 days between onset of event 1 and onset of event 2

How Is "Abnormality" In Paraclinical Tests Determined?

A- Magnetic resonance imaging (MRI): Three out of four:

  • 1 Gd-enhancing or 9 T2 hyperintense lesions if no Gd-enhancing lesion
  • 1 or more infratentorial lesions
  • 1 or more juxtacortical lesions
  • 3 or more periventricular lesions

(1 spinal cord lesion = 1 brain lesion)

B- Cerebrospinal fluid (CSF)

  • Oligoclonal IgG bands in CSF (and not serum)
  • or elevated IgG index

C- Evoked potentials (EP)

  • Delayed but well-preserved wave form

What Provides MRI Evidence Of Dissemination In Time?

A Gd-enhancing lesion demonstrated in a scan done at least 3 months following onset of clinical attack at a site different from attack,
or
In absence of Gd-enhancing lesions at 3 month scan, follow-up scan after an additional 3 months showing Gd-lesion or new T2 lesion.

Steps in Making a Diagnosis of MS

Clinical Presentation

Additional Data Needed

2 or more attacks (relapses)

2 or more objective clinical lesions

None; clinical evidence will suffice
(additional evidence desirable but must be consistent with MS)

2 or more attacks

1 objective clinical lesion

Dissemination in space, demonstrated by:
MRI
or a positive CSF and 2 or more MRI lesions consistent with MS
or further clinical attack involving different site

1 attack

2 or more objective clinical lesions

Dissemination in time, demonstrated by:
MRI
or second clinical attack

1 attack

1 objective clinical lesion
(monosymptomatic presentation)

Dissemination in space, demonstrated by:
MRI
or positive CSF and 2 or more MRI lesions consistent with MS

and

Dissemination in time demonstrated by:
MRI
or second clinical attack

Insidious neurological progression suggestive of MS
(primary progressive MS)

Positive CSF

and

Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion

and

Dissemination in time demonstrated by:
MRI
or continued progression for 1 year

 

References:

1.      McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001 Jul;50(1):121-7. [Medline]

Created: August 09, 2005
Last Modified: 03/04/2006