EDMUS

MS diagnostic criteria according to McDonald et al. (2010)

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) and in 2010 (Polman et al. 2010).

In blue: criteria for dissemination in time (DIT)
In red: criteria for dissemination in space (DIS)

Clinical presentation (Possible MS)		Additional requirements to make diagnosis (MS)
Attacks (relapses)	Objective clinical lesions
2 or more	2 or more	None, clinical evidence alone will suffice (additional evidence desirable but must be consistent with MS)
2 or more	1	DIS, demonstrated by:
			>=1 T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord)
		or	Further clinical attack implicating a different CNS site
1	2 or more	DIT, demonstrated by:
			Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time
		or	A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan
		or	Second clinical attack
1	1 (CIS: clinically isolated syndrome)	DIS, demonstrated by:
			>=1 T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord)
		or	Second clinical attack implicating a different CNS site
		AND DIT, demonstrated by:
			Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time
		or	A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan
		or	Second clinical attack
0 Insidious neurological progression suggestive of MS (PPMS: primary progressive MS)	0	DIT: One year of disease progression (retrospectively or prospectively determined)
		AND 2 or 3 of the following criteria:
			Evidence for DIS in the brain based on >=1 T2 lesions in the MS-characteristic (periventricular, juxtacortical, or infratentorial) regions
		or	Evidence for DIS in the spinal cord based on >=2 T2 lesions in the cord
		or	Positive CSF (evidence of oligoclonal bands and/or elevated IgG index)

Paraclinical evidence in MS diagnosis

2010 McDonald MRI criteria for demonstration of DIS (Swanton criteria)

>=1 T2 lesion in at least 2 of 4 areas of the CNS:

• periventricular
• juxtacortical
• inftatentorial
• spinal cord

(Gadolinium enhancement of lesions is not required for DIS)

2005 McDonald MRI criteria for demonstration of DIS (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.

2010 McDonald MRI criteria for demonstration of DIT

One of the following:

• A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, with reference to a baseline scan, irrespective of the timing of the baseline MRI
• Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time

2010 McDonald criteria for diagnosis of MS in disease with progression from onset

PPMS may be diagnosed in subjects with:

• One year of disease progression (retrospectively or prospectively determined
• Plus 2 of the 3 following criteria:
  • Evidence for DIS in the brain based on >=1 T2 lesions in at least 1 area characteristic for MS (periventricular, juxtacortical, or infratentorial)
  • Evidence for DIS in the spinal cord based on >=2 T2 lesions in the cord
  • Positive CSF (IEF evidence of oligoclonal bands and/or elevated IgG index)