{"id":2512,"date":"2009-03-08T12:02:29","date_gmt":"2009-03-08T12:02:29","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/neuroms\/"},"modified":"2025-05-14T19:10:26","modified_gmt":"2025-05-14T19:10:26","slug":"neuroms","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/neuroms\/","title":{"rendered":"McDonald Diagnostic Criteria for 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><\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">What Is An Attack? <\/span><\/strong><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"color: black;\">Neurological disturbance of kind seen in MS<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">Subjective report or objective observation<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">24 hours duration, minimum<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">Excludes pseudoattacks, single paroxysmal episodes <!--more--><\/li>\n<\/ul>\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">Determining Time Between Attacks <\/span><\/strong><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"color: black;\">30 days between onset of event 1 and onset of event 2<\/li>\n<\/ul>\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">How Is &#8220;Abnormality&#8221; In Paraclinical Tests Determined? <\/span><\/strong><\/p>\n<p class=\"MsoNormal\"><span style=\"color: black;\">A- Magnetic resonance imaging (MRI): Three out of four: <\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"color: black;\">1 Gd-enhancing or 9 T2 hyperintense lesions if no Gd-enhancing lesion<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">1 or more infratentorial lesions<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">1 or more juxtacortical lesions<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">3 or more periventricular lesions<\/li>\n<\/ul>\n<p class=\"MsoNormal\" style=\"margin-left: 18pt;\"><span style=\"color: black;\">(1 spinal cord lesion = 1 brain lesion) <\/span><\/p>\n<p class=\"MsoNormal\"><span style=\"color: black;\">B- Cerebrospinal fluid (CSF) <\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"color: black;\">Oligoclonal IgG bands in CSF (and not serum)<\/li>\n<li class=\"MsoNormal\" style=\"color: black;\">or elevated IgG index<\/li>\n<\/ul>\n<p class=\"MsoNormal\"><span style=\"color: black;\">C- Evoked potentials (EP) <\/span><\/p>\n<ul style=\"margin-top: 0cm;\">\n<li class=\"MsoNormal\" style=\"color: black;\">Delayed but well-preserved wave form<\/li>\n<\/ul>\n<p class=\"MsoNormal\"><strong><span style=\"color: black;\">What Provides MRI Evidence Of Dissemination In Time? <\/span><\/strong><\/p>\n<p class=\"MsoNormal\"><span style=\"color: black;\">A Gd-enhancing lesion demonstrated in a scan done at least 3 months following onset of clinical attack at a site different from attack,<br \/>\n<strong><em>or <\/em><\/strong><\/span><br \/>\n<span style=\"color: black;\">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. <\/span><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 432.2pt;\" colspan=\"2\" valign=\"top\" width=\"576\">\n<p class=\"MsoNormal\" style=\"text-align: center;\" align=\"center\"><strong><span style=\"color: black;\">Steps in Making a Diagnosis of MS<\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Clinical Presentation<\/span><\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Additional Data Needed<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">2 or more attacks (relapses)<\/span><\/p>\n<p><span style=\"color: black;\">2 or more objective clinical lesions<\/span><\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">None; clinical evidence will suffice<\/span><br \/>\n<span style=\"color: black;\">(additional evidence desirable but must be consistent with MS)<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">2 or more attacks<\/span><\/p>\n<p><span style=\"color: black;\">1 objective clinical lesion<\/span><\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">space<\/span>, demonstrated by:<\/span><br \/>\n<span style=\"color: black;\">MRI<\/span><br \/>\n<strong><em><span style=\"color: black;\">or<\/span><\/em><\/strong><span style=\"color: black;\"> a positive CSF and 2 or more MRI lesions consistent with MS<\/span><br \/>\n<strong><em><span style=\"color: black;\">or<\/span><\/em><\/strong><span style=\"color: black;\"> further clinical attack involving different site<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">1 attack<\/span><\/p>\n<p><span style=\"color: black;\">2 or more objective clinical lesions<\/span><\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">time<\/span>, demonstrated by:<\/span><br \/>\n<span style=\"color: black;\">MRI<\/span><br \/>\n<strong><em><span style=\"color: black;\">or<\/span><\/em><\/strong><span style=\"color: black;\"> second clinical attack<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">1 attack <\/span><\/p>\n<p><span style=\"color: black;\">1 objective clinical lesion <\/span><br \/>\n<span style=\"color: black;\">(monosymptomatic presentation)<\/span><\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">space<\/span>, demonstrated by: <\/span><br \/>\n<span style=\"color: black;\">MRI <\/span><br \/>\n<strong><em><span style=\"color: black;\">or<\/span><\/em><\/strong><span style=\"color: black;\"> positive CSF and 2 or more MRI lesions consistent with MS <\/span><\/p>\n<p><strong><em><span style=\"color: black;\">and <\/span><\/em><\/strong><br \/>\n<span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">time<\/span> demonstrated by: <\/span><br \/>\n<span style=\"color: black;\">MRI <\/span><br \/>\n<strong><em><span style=\"color: black;\">or<\/span><\/em><\/strong><span style=\"color: black;\"> second clinical attack<\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"padding: 0cm 5.4pt; width: 167.4pt; border: medium 1pt 1pt none solid solid -moz-use-text-color windowtext windowtext;\" valign=\"top\" width=\"223\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Insidious neurological progression<\/span><span style=\"color: black;\"> suggestive of MS <\/span><br \/>\n<span style=\"color: black;\">(primary progressive MS)<\/span><\/p>\n<\/td>\n<td style=\"padding: 0cm 5.4pt; width: 264.8pt; border: medium 1pt 1pt medium none solid solid none -moz-use-text-color windowtext windowtext -moz-use-text-color;\" valign=\"top\" width=\"353\">\n<p class=\"MsoNormal\"><span style=\"color: black;\">Positive CSF <\/span><\/p>\n<p><strong><em><span style=\"color: black;\">and <\/span><\/em><\/strong><br \/>\n<span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">space <\/span>demonstrated by: <\/span><br \/>\n<span style=\"color: black;\">MRI evidence of 9 or more T2 brain lesions <\/span><br \/>\n<span style=\"color: black;\">or 2 or more spinal cord lesions <\/span><br \/>\n<span style=\"color: black;\">or 4-8 brain and 1 spinal cord lesion <\/span><br \/>\n<span style=\"color: black;\">or positive VEP with 4-8 MRI lesions <\/span><br \/>\n<span style=\"color: black;\">or positive VEP with &lt;4 brain lesions plus 1 spinal cord lesion<\/span><br \/>\n<strong><em><span style=\"color: black;\">and <\/span><\/em><\/strong><br \/>\n<span style=\"color: black;\">Dissemination in <span style=\"text-decoration: underline;\">time<\/span> demonstrated by: <\/span><br \/>\n<span style=\"color: black;\">MRI <\/span><br \/>\n<span style=\"color: black;\"><strong><em>or<\/em><\/strong> continued progression for 1 year <\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\">\n<\/div>\n<div class=\"Section1\">\n<p class=\"MsoNormal\"><strong>References:<\/strong><\/p>\n<div class=\"Section1\">\n<p class=\"MsoNormal\" style=\"margin-left: 27pt; text-indent: -18pt;\">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. <span style=\"color: blue;\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11456302\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"color: blue;\">[Medline]<\/span><\/a><\/span><\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p>Created: Aug 09, 2005<\/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":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[2],"tags":[16,15,14,13,94,471,470,469,1300,93],"class_list":["post-2512","post","type-post","status-publish","format-standard","hentry","category-neurology","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-esclerosis","tag-mcdonald","tag-ms","tag-multiple","tag-neurology","tag-sclerosis"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2512","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=2512"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2512\/revisions"}],"predecessor-version":[{"id":9148,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2512\/revisions\/9148"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2512"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2512"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}