Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

Abstract

The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.

ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis

“…12,13 There is still controversy about the relative efficacy of the drugs available, who should receive therapy and the optimum time to start. The heterogeneity of MS together with the changes in the diagnostic criteria over the years [14][15][16][17] and the recent redefinition of the clinical subtypes 18 hamper direct comparisons across studies for different drugs. Moreover, despite the identification of several prognostic factors, [19][20][21] there is no accepted consensus definition that allows physicians to classify patients into 'high-risk' and 'low-risk' groups in order to prioritize treatment strategies.…”

Early predictors of conversion in patients with clinically isolated syndrome: a preliminary Egyptian study

“…Clinically isolated syndrome (CIS) refers to a monophasic clinical episode with patient-reported symptoms and objective findings reflecting a focal or multifocal inflammatory demyelinating event in the central nervous system (CNS), developing acutely or sub acutely, with a duration of at least 24 h, with or without recovery, and in the absence of fever or infection, similar to a typical multiple sclerosis relapse (attack and exacerbation) but in a patient not known to have multiple sclerosis (Thompson et al 2018).…”

Clinically and Radiological isolated syndrome (MS risk)

“…MRI criteria for MS are based on the presence of focal lesions in the white and /or gray matter of the CNS, which are considered typical for this condition in terms of distribution, morphology, evolution, and signal abnormalities on conventional MRI sequences (T2-weighted, FLAIR, pre-and post-contrast T1-weighted scans) [3]. According to the 2017 revision of McDonald criteria, including two major changes, irst is the early diagnosis of MS in patients with CIS with dissemination in space and +ve OCBs, without waiting for dissemination in time, second is, symptomatic or asymptomatic MRI lesions (except those in the optic nerve) can be considered as dissemination in space or time [4]. Incidental MR imaging indings resembling MS without typical MS symptoms are termed RIS, it was introduced in 2009 by Okuda to categorize incidental WM lesions suggestive of demyelinating disease in patients without typical MS symptoms and no better explanation for the MR imaging anomalies [5].…”

“…Incidental MR imaging indings resembling MS without typical MS symptoms are termed RIS, it was introduced in 2009 by Okuda to categorize incidental WM lesions suggestive of demyelinating disease in patients without typical MS symptoms and no better explanation for the MR imaging anomalies [5]. CSF analysis was one of the main paraclinical diagnostic criteria for MS (it is mandatory in the 2017 revision of McDonald criteria for MS); nowadays, it is of great importance in differential diagnosis of MS [4]. The presence of ≥2 OCBs in the CSF have a positive predictive value of 97%, negative predictive value of 84%, sensitivity of 91%, and speci icity of 94% for developing (relapsing remitting MS) RRMS after a CIS [5] (Tables 1,2).…”