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Updates to Mc Donald Criteria

Getting a clear and timely diagnosis of multiple sclerosis (MS) can make a big difference to care, treatment, and peace of mind. To guide this process, doctors around the world use the McDonald criteria – a set of internationally agreed rules first introduced in 2001 and regularly updated as science advances.

In 2024, these criteria were revised again by an international panel of experts, including clinicians, researchers and patient representatives. The goal was to make MS diagnosis more accurate, less invasive, and more accessible worldwide.

Here are the main changes and what they mean:

  • Earlier diagnosis in some cases
    Until now, doctors often needed to see evidence that MS activity happened at more than one point in time. The updated criteria allow a diagnosis after a single clinical event if there is strong supporting evidence, such as MRI or spinal fluid results. This should reduce delays for many people.

     

  • The optic nerve is now included
    MS affects different areas of the central nervous system. The optic nerve has now been formally added as one of these areas. This means tests like optical coherence tomography (OCT) and visual evoked potentials may be used as part of diagnosis.

     

  • Clearer guidance for Radiologically Isolated Syndrome (RIS)
    RIS refers to people who have MRI findings typical of MS but no symptoms yet. The new criteria outline when RIS can lead to an MS diagnosis, allowing closer monitoring or, in some cases, earlier treatment.

 

  • More support for specific groups
    Special criteria have been added for children, older adults and people with vascular risk factors. This helps reduce misdiagnosis in groups where MS can be harder to distinguish from other conditions.

 

  • New biological and imaging markers recognised
    • Advanced MRI signs such as the central vein sign and paramagnetic rim lesions are acknowledged as useful supportive evidence.
    • Kappa free light chains in spinal fluid are now accepted as an alternative to oligoclonal bands.
  • Diagnosis even before symptoms in select cases
    In very specific situations, people with strong biological or MRI evidence may meet the criteria before symptoms appear. This reflects advances in detecting MS very early, though decisions about treatment remain complex and highly individual.

 

What This May Mean for You

  • If you are experiencing symptoms but not yet diagnosed, these changes may shorten the time to diagnosis. For example, you might no longer need to wait for a second event if imaging or other tests provide strong evidence. The inclusion of the optic nerve also widens the diagnostic tools available.
  • If you are in Radiologically Isolated Syndrome (RIS), the new criteria offer clearer guidance about when diagnosis and treatment might be appropriate even before MS symptoms begin.  

To find out more visit: https://ectrims.eu/press/revisions-to-mcdonald-diagnostic-criteria-for-…

 

 

 

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