New Criteria for Diagnosing Multiple Sclerosis
by Diane Holmes on Tuesday, February 12, 2019
The 1965 Schumacher Criteria was first official method for diagnosing Multiple Sclerosis (MS). Diagnosis was based on symptoms identified by the physician. In 1983 the Poser Criteria added evoked potentials, spinal tap, and lesion damage at different times and in different areas of the central nervous system, referred to as separated by time and space. In 2001 the McDonald Criteria became the standard for diagnosing MS, with updates in 2005 and 2010.
Then, the 2017 McDonald Criteria was presented at the 7th Joint European Committee for Treatment and Research in Multiple Sclerosis - Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS). Changes included the addition of Clinically Isolated Syndrome (CIS), a single episode with one symptom caused by one lesion (Monofocal episode) or more than one symptom caused by lesions is in more than one place (Multifocal episode), as well as abnormalities in the Cerebral Spinal Fluid.
The 2017 McDonald Criteria includes:
- People with clinically isolated syndrome (CIS) and clinical symptoms or MRI lesions in two areas of the body, and Cerebral Spinal Fluid (CSF) with specific oligoclonal bands, can be diagnosed with MS without a time lapse between episodes.
- MRI lesions, with or without accompanying symptoms can be used to meet the separation of time and space requirements. [Previously, only symptomatic lesions in specific locations could be used.]
- Lesions between the brain’s gray matter and white matter, as well as in the cortex can be used for the separation in space requirement. [Previously cortical lesions could not be used.]
- Diagnostic requirements for primary progressive MS have not changed, with the exception of allowing both symptomatic and asymptomatic lesions, as well as cortical lesions for diagnosis.
- A provisional disease course can be identified at the time of diagnosis with re-evaluation later.
Four presentations at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in October 2018 found a 25% increase in identified cases of MS, as well as an increase in the diagnosis of MS in children as young as 5, using the new Criteria. A Spanish study found it took less time to identify MS progression, with the new Criteria, in people initially diagnosed with CIS. A second study, in the Netherlands, found 54% of people with CIS could be diagnosed with MS using the new Criteria, compared to 26% using the 2010 Criteria, largely because of the presence of oligoclonal bands. A British study of children found increased accuracy of diagnosis using the 2017 Criteria. The same study found the first relapse occurred 6 months later, much faster than in adults.
Overall, the 2017 McDonald Criteria was found to be more accurate and specific than
the 2010 Criteria when diagnosing MS.
* Kreiger, S.; How Have the 2017 McDonald Criteria Affected MS Diagnosis?; Oct. 3, 2018
* McNamara D.; McDonald Criteria 2017 Boost MS Diagnoses by 25%; Oct. 23, 2018
* Hughes, S.; New MS Diagnostic Criteria Will Allow Earlier Diagnosis; Oct. 27, 2017
* Helwick, C.; Revisions Underway to McDonald Criteria on MS Diagnosis; May 26, 2017
Guidelines for MS Diagnosis: McDonald Criteria
* Diagnosing MS
* Clinically Isolated Syndrome (CIS)
van den Noort, S., Holland, N.; Multiple Sclerosis and Clinical Practice; p.13-14; 1999