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McDonald Diagnostic Criteria for Multiple Sclerosis (MS) |
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Written by G. Firman MD
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Sunday, 08 March 2009 04:02 |
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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,
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. | 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:
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, 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 | References: 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] Created: August 09, 2005
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Last Updated on Tuesday, 24 January 2012 07:59 |
