Photo Credit: Jitendra Jadhav

The revised McDonald criteria allow the diagnosis of MS in certain cases in asymptomatic people who have had a radiologically isolated syndrome (RIS). Dissemination in time (DIT) should no longer be required. Optic nerve imaging for diagnosis may, in certain cases, be a fifth anatomical location.

The ECTRIMS 2024 meeting dedicated a session to the draft revision of the McDonald diagnostic criteria for MS. This is an initiative of the International Advisory Committee on Clinical Trials in MS, presided by Xavier Montalban, MD, PhD, from the Vall d’Hebron University Hospital, in Spain. He presented the most important upcoming revisions of the 2017 version of the McDonald criteria^1,2.

The first and most fundamental change Prof. Montalban mentioned was that RIS is considered MS in specific situations. This allows for diagnosing MS in asymptomatic people. “This means we are moving toward a biological diagnosis, which is happening as well in other neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease.”

The other proposed revisions include the following:

• The optic nerve may be a fifth anatomical location to demonstrate dissemination in space (DIS) —assessed by MRI, visual evoked potential, or optical coherence tomography— if no better explanation for topic nerve pathology can be found.
• DIT is no longer required.
• DIS criteria have been updated: DIS criteria are fulfilled when two out of five topographies show typical lesions, whether these are symptomatic or not.
• Kappa-free light chain is a diagnostic marker for MS.
• Criteria for diagnosing primary progressive MS and relapsing MS are now the same.
• Paraclinical evidence is needed to diagnose MS.
• Stricter features should be used to diagnosis MS in people older than 50 years of age, with headache disorders (including migraine), or with vascular disorders.
• Central vein sign and a paramagnetic rim lesion are added as optional tools to help diagnose MS in certain situations.
• Laboratory tests (e.g. MOG-IgG-Ab) are recommended to confirm the diagnosis in children and adolescents.

Medical writing support was provided by Michiel Tent

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