{"id":2203,"date":"2018-04-18T21:08:19","date_gmt":"2018-04-18T21:08:19","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1021"},"modified":"2025-05-13T20:24:58","modified_gmt":"2025-05-13T20:24:58","slug":"2017-mcdonald","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/2017-mcdonald\/","title":{"rendered":"The 2017 McDonald Criteria for Diagnosis of Multiple Sclerosis (MS)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>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.<!--more--><br \/>\n<strong>Definitions<\/strong><\/p>\n<ul>\n<li><strong>Attack:<\/strong>\u00a0Attack, relapse, exacerbation, and (when it is the first episode)\u00a0clinically isolated syndrome are synonyms. See clinically isolated\u00a0syndrome and relapse for descriptions.<\/li>\n<li><strong>Clinically isolated syndrome:<\/strong>\u00a0A monophasic clinical episode with patient-reported\u00a0symptoms and objective findings reflecting a focal or\u00a0multifocal inflammatory demyelinating event in the CNS,\u00a0developing acutely or subacutely, with a duration of at least\u00a024 h, with or without recovery, and in the absence of fever or\u00a0infection; similar to a typical multiple sclerosis relapse (attack\u00a0and exacerbation) but in a patient not known to have multiple\u00a0sclerosis. Thus, if the patient is subsequently diagnosed with\u00a0multiple sclerosis (by fulfilling dissemination in space and\u00a0time, and ruling out other diagnoses), the clinically isolated\u00a0syndrome was that patient\u2019s first attack. A clinically isolated\u00a0syndrome can be monofocal (reflecting pathology in a single\u00a0location) or multifocal; the specific manifestations of a\u00a0clinically isolated syndrome depend on the anatomical\u00a0location (or locations) of the pathology. Typical presentations\u00a0include unilateral optic neuritis, focal supratentorial\u00a0syndrome, focal brainstem or cerebellar syndrome, or partial\u00a0myelopathy; examples of atypical presentations include\u00a0bilateral optic neuritis, complete ophthalmoplegia, complete\u00a0myelopathy, encephalopathy, headache, alteration of\u00a0consciousness, meningismus, or isolated fatigue.<\/li>\n<li><strong>Cortical MRI lesions:<\/strong> Lesions within the cerebral cortex. Typically, special MRI\u00a0techniques such as double inversion recovery, phase-sensitive\u00a0inversion recovery, and magnetisation-prepared rapid\u00a0acquisition with gradient echo sequences are required to\u00a0visualize these lesions. The lesions detected by these\u00a0techniques are primarily of the leukocortical type; subpial\u00a0lesions are rarely detected. Care is needed to distinguish\u00a0potential cortical lesions from neuroimaging artefacts.<\/li>\n<li><strong>Dissemination in space:<\/strong>\u00a0The development of lesions in distinct anatomical locations\u00a0within the CNS &#8211; ie, indicating a multifocal CNS process.<\/li>\n<li><strong>Dissemination in time:<\/strong>\u00a0The development or appearance of new CNS lesions over time.<\/li>\n<li><strong>Exacerbation:<\/strong>\u00a0Attack, relapse, exacerbation, and (when it is the first episode)\u00a0clinically isolated syndrome are synonyms. See clinically isolated\u00a0syndrome and relapse for descriptions.<\/li>\n<li><strong>Infratentorial MRI lesion:\u00a0<\/strong>A T2-hyperintense lesion in the brainstem (typically near the\u00a0surface), cerebellar peduncles, or cerebellum.<\/li>\n<li><strong>Juxtacortical MRI lesion:<\/strong>\u00a0A T2-hyperintense cerebral white matter lesion abutting the\u00a0cortex, and not separated from it by white matter.<\/li>\n<li><strong>Lesion:<\/strong>\u00a0An area of hyperintensity on a T2-weighted or proton-density weighted\u00a0MRI scan that is at least 3 mm in long axis.<\/li>\n<li><strong>Objective clinical or paraclinical evidence (as it relates to a<\/strong><br \/>\n<strong> current or historical attack):\u00a0<\/strong>An abnormality on neurological examination, imaging (MRI or\u00a0optical coherence tomography), or neurophysiological testing\u00a0(visual evoked potentials) that corresponds to the anatomical\u00a0location suggested by the symptoms of the clinically isolated\u00a0syndrome\u2014eg, optic disc pallor or a relative afferent pupillary\u00a0defect, optic nerve T2 hyperintensity on MRI, retinal nerve fibre\u00a0layer thinning on optical coherence tomography, or\u00a0P100 latency prolongation on visual evoked potentials in a\u00a0patient reporting a previous episode of self-limited, painful,\u00a0monocular visual impairment. Caution should be exercised in\u00a0accepting symptoms accompanied only by patient-reported\u00a0subjective alteration as evidence of a current or previous attack.<\/li>\n<li><strong>Periventricular MRI lesion:\u00a0<\/strong>A T2-hyperintense cerebral white matter lesion abutting the\u00a0lateral ventricles without white matter in between, including\u00a0lesions in the corpus callosum but excluding lesions in deep\u00a0grey matter structures.<\/li>\n<li><strong>Progressive course:<\/strong> A multiple sclerosis course characterized by steadily increasing\u00a0objectively documented neurological disability independent of\u00a0relapses. Fluctuations, periods of stability, and superimposed\u00a0relapses might occur. Primary progressive multiple sclerosis\u00a0(a progressive course from disease onset) and secondary\u00a0progressive multiple sclerosis (a progressive course following an\u00a0initial relapsing-remitting course) are distinguished.<\/li>\n<li><strong>Radiologically isolated syndrome:<\/strong>\u00a0MRI findings strongly suggestive of multiple sclerosis in a\u00a0patient with no neurological manifestations or other clear-cut\u00a0explanation.<\/li>\n<li><strong>Relapse:\u00a0<\/strong>A monophasic clinical episode with patient-reported symptoms\u00a0and objective findings typical of multiple sclerosis, reflecting a\u00a0focal or multifocal inflammatory demyelinating event in the\u00a0CNS, developing acutely or subacutely, with a duration of at\u00a0least 24 h, with or without recovery, and in the absence of fever\u00a0or infection. Attack, relapse, exacerbation, and (when it is the\u00a0first episode) clinically isolated syndrome are synonyms.<\/li>\n<li><strong>Relapsing-remitting course:<\/strong> A multiple sclerosis course characterized by relapses with stable\u00a0neurological disability between episodes.<\/li>\n<li><strong>Spinal cord MRI lesion:\u00a0<\/strong>A hyperintense lesion in the cervical, thoracic, or lumbar spinal\u00a0cord seen on T2 plus short tau inversion recovery,\u00a0proton-density images, or other appropriate sequences, or in\u00a0two planes on T2 images.<\/li>\n<\/ul>\n<p><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script><br \/>\n<ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-0127150553352455\" data-ad-slot=\"7834404329\"><\/ins><br \/>\n<script>\n     (adsbygoogle = window.adsbygoogle || []).push({});\n<\/script><br \/>\n<strong>The 2017 McDonald Criteria for Diagnosis of Multiple Sclerosis (MS)<\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td><\/td>\n<td style=\"text-align: center;\">Number of lesions with objective clinical evidence<\/td>\n<td>Additional data needed for a diagnosis of multiple sclerosis<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\">\u22652 clinical attacks<\/td>\n<td style=\"text-align: center;\">\u22652<\/td>\n<td>None*<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\">\u22652 clinical attacks<\/td>\n<td style=\"text-align: center;\">1<br \/>\n(as well as clear-cut historical evidence of a previous attack involving a lesion in a distinct anatomical location\u2020)<\/td>\n<td>None*<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\">\u22652 clinical attacks<\/td>\n<td style=\"text-align: center;\">1<\/td>\n<td>Dissemination in space demonstrated by an additional clinical attack\u00a0implicating a different CNS site or by MRI<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\">1 clinical attack<\/td>\n<td style=\"text-align: center;\">\u22652<\/td>\n<td>Dissemination in time demonstrated by an additional clinical attack or by\u00a0MRI\u00a7 OR demonstration of CSF-specific oligoclonal bands\u00b6<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\">1 clinical attack<\/td>\n<td style=\"text-align: center;\">1<\/td>\n<td>Dissemination in space demonstrated by an additional clinical attack\u00a0implicating a different CNS site or by MRI<br \/>\nAND<br \/>\nDissemination in time demonstrated by an additional clinical attack or by\u00a0MRI\u00a7 OR demonstration of CSF-specific oligoclonal bands\u00b6<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>If the 2017 McDonald Criteria are fulfilled and there is no better explanation for the clinical presentation, the diagnosis is multiple sclerosis. If multiple sclerosis is suspected by\u00a0virtue of a clinically isolated syndrome but the 2017 McDonald Criteria are not completely met, the diagnosis is possible multiple sclerosis. If another diagnosis arises during the\u00a0evaluation that better explains the clinical presentation, the diagnosis is not multiple sclerosis.<\/p>\n<p>*No additional tests are required to demonstrate\u00a0dissemination in space and time. However, unless MRI is not possible, brain MRI should be obtained in all patients in whom the diagnosis of multiple sclerosis is being\u00a0considered. In addition, spinal cord MRI or CSF examination should be considered in patients with insufficient clinical and MRI evidence supporting multiple sclerosis, with a\u00a0presentation other than a typical clinically isolated syndrome, or with atypical features. If imaging or other tests (eg, CSF) are undertaken and are negative, caution needs to be\u00a0taken before making a diagnosis of multiple sclerosis, and alternative diagnoses should be considered.<br \/>\n\u2020Clinical diagnosis based on objective clinical findings for two attacks is\u00a0most secure. Reasonable historical evidence for one past attack, in the absence of documented objective neurological findings, can include historical events with symptoms\u00a0and evolution characteristic for a previous inflammatory demyelinating attack; at least one attack, however, must be supported by objective findings. In the absence of residual\u00a0objective evidence, caution is needed.<br \/>\n\u00a7The MRI criteria for dissemination in space and time.<\/p>\n<ul>\n<li>Dissemination in space can be demonstrated by one or more T2-hyperintense lesions\u00a0that are characteristic of multiple sclerosis in two or more of four areas of the CNS:\u00a0periventricular,\u2020 cortical or juxtacortical, and infratentorial brain regions, and the\u00a0spinal cord<\/li>\n<li>Dissemination in time can be demonstrated by the simultaneous presence of\u00a0gadolinium-enhancing and non-enhancing lesions* at any time or by a new\u00a0T2-hyperintense or gadolinium-enhancing lesion on follow-up MRI, with reference to\u00a0a baseline scan, irrespective of the timing of the baseline MRI<\/li>\n<\/ul>\n<p>\u00b6The presence of CSF-specific oligoclonal bands does not demonstrate dissemination in time per se but can substitute for the requirement for demonstration of this measure.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintor\u00e9 M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.\u00a0Lancet Neurol. 2018 Feb;17(2):162-173. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29275977\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Filippi M, Preziosa P, Meani A, Ciccarelli O, Mesaros S, Rovira A, Frederiksen J, Enzinger C, Barkhof F, Gasperini C, Brownlee W, Drulovic J, Montalban X, Cramer SP, Pichler A, Hagens M, Ruggieri S, Martinelli V, Miszkiel K, Tintor\u00e8 M, Comi G, Dekker I, Uitdehaag B, Dujmovic-Basuroski I, Rocca MA. Prediction of a multiple sclerosis diagnosis in patients with clinically isolated syndrome using the 2016 MAGNIMS and 2010 McDonald criteria: a retrospective study.\u00a0Lancet Neurol. 2018 Feb;17(2):133-142. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29275979\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Mar 27, 2018.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[2],"tags":[424,16,15,123,13,472,94,471,470,469,93],"class_list":["post-2203","post","type-post","status-publish","format-standard","hentry","category-neurology","tag-424","tag-criteria","tag-criterios","tag-diagnosis","tag-diagnostico","tag-em","tag-esclerosis","tag-mcdonald","tag-ms","tag-multiple","tag-sclerosis"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2203"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2203\/revisions"}],"predecessor-version":[{"id":8799,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2203\/revisions\/8799"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2203"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2203"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}