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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,

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:
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:
or second clinical attack

1 attack

1 objective clinical lesion
(monosymptomatic presentation)

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


Dissemination in time demonstrated by:
or second clinical attack

Insidious neurological progression suggestive of MS
(primary progressive MS)

Positive CSF


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


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


Related Criteria

NIH Diagnostic Criteria for Neurofibromatosis

Diagnostic Criteria for Tuberous Sclerosis Complex (TSC)

Diagnostic Criteria for Neurocysticercosis

Diagnostic Criteria and Associated Features of Restless Legs Syndrome (RLS)

Diagnostic Criteria for Parkinsonís Disease (PD)




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]

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Created: August 09, 2005
Last Modified: 10/23/2010

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