This page describes the April 2001 McDonald criteria. It is preserved as a historical document and must not be used as current diagnostic guidance. The archive capture date does not update the criteria described.

In April, 2001, an international panel in association with the NMSS of America recommended revised diagnostic criteria for multiple sclerosis. These new criteria have become known as the McDonald criteria after their lead author. They make use of advances in MRI imaging techniques and are intended to replace the Poser Criteria and the older Schumacher Criteria. The new revised criteria are as follows:

Clinical Presentation

Additional Data Needed

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 by 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

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?

  • 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)

  • Cerebrospinal fluid (CSF)

    • Oligoclonal IgG bands in CSF (and not serum)

    • or elevated IgG index

  • 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.

Diagnostic Criteria links:

International Panel Revises Diagnostic Criteria For MS

Recommended diagnostic criteria for multiple sclerosis

Source details

Author: Paul Jones

Archive capture: . This is not a medical review date.

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