Multiple sclerosis can be diagnosed using the 2017 revision of the McDonald criteria.
Parameters:
(1) number of clinical attacks
(2) number of lesions with objective clinical evidence
(3) additional data need for a diagnosis of multiple sclerosis
Clinical Attacks
Number of Lesions
Additional Data
>= 2
>= 2
none
>= 2
1 + 1 historical event
none
>= 2
1
dissemination in space
1
>= 2
dissemination in time OR CSF specific oligoclonal bands
1
1
dissemination in space AND (dissemination in time OR CSF specific oligoclonal bands)
where:
• Historical event = clear-cut evidence of a previous attack involving a lesion in a distinct anatomical location
If another diagnosis arises during the evaluation that better explains the clinical presentation, then the diagnosis is not multiple sclerosis. If imaging or other tests (eg, CSF) are negative, then caution needs to be taken before making a diagnosis of multiple sclerosis.
Spinal cord MRI or CSF examination should be considered in patients with insufficient clinical and MRI evidence supporting multiple sclerosis, with a presentation other than a typical clinically isolated syndrome, or with atypical features.
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