MS diagnostic criteria according to McDonald et al.

In April 2001 an international panel recommended new diagnostic criteria for MS (McDonald et al. 2001). The McDonald criteria were revised in 2005 (Polman et al. 2005).

McDonald WI, Compston DAS, Edan G, et al. Recommended diagnostic criteria for MS: Guidelines from the international panel on the diagnosis of MS. Ann. Neurol. 2001; 50: 121-127

Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann. Neurol. 2005; 58: 840–846

Barkhof F, Filippi M, Miller DH, et al. Comparison of MR imaging criteria at first presentation to predict conversion to clinically definite MS. Brain 1997; 120: 2059-2069

Download the "McDonald diagnostic criteria" document (PDF format)

In blue: criteria for dissemination in time
In red: criteria for dissemination in space

Clinical presentation (Possible MS) Additional requirements
to make diagnosis
(MS)
Attacks
(relapses)		 Objective
lesions
2
or
more		 2
or
more		 None, clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
2
or
more		 1 Dissemination in space,
demonstrated by 1 or more of these 3 criteria:
 
  • Dissemination in space by MRI
or
  • Positive CSF
    and 2 or more MRI lesions consistent with MS
or
  • Further clinical attack involving different site
1 2
or
more		 Dissemination in time,
demonstrated by 1 or more of these 2 criteria:
 
  • Dissemination in time by MRI
or
  • Second clinical attack
1 1 Dissemination in space,
demonstrated by 1 or more of these 2 criteria:
 
  • Dissemination in space by MRI
or
  • Positive CSF
    and 2 or more MRI lesions consistent with MS
AND dissemination in time,
demonstrated by 1 or more of these 2 criteria:
 
  • Dissemination in time by MRI
or
  • Second clinical attack
0

Insidious
neurological
progression
suggestive
of MS

(primary
progressive MS)		 0 Dissemination in time:
One year of disease progression
AND dissemination in space
demonstrated by 2 or more of the following:
 
  • Positive brain MRI (9 T2 lesions, or 4 or more T2 lesions with positive VEP)
or
  • Positive spinal cord MRI (two focal T2 lesions)
or
  • Positive CSF findings

Paraclinical evidence in MS diagnosis

What is a positive MRI? (Barkhof criteria)
3 out of 4 of the following:
  • 1 Gd-enhancing lesion,
    or 9 T2 hyperintense lesions if no Gd-enhancing lesion
  • 1 or more infratentorial lesion(s)
  • 1 or more juxtacortical lesion(s)
  • 3 or more periventricular lesions
Note: 1 cord lesion can substitute for 1 brain lesion.
What provides MRI evidence of dissemination in time?
One of the following:
  • 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
What is positive CSF?
One of the following:
  • Oligoclonal IgG bands in CSF (and not serum)
  • Elevated IgG index
What is positive VEP?
Delayed but well-preserved wave form