Diagnostic Criteria for Multiple Sclerosis from the International Panel on the Diagnosis of Multiple Sclerosis (McDonald 2001 Criteria)

 

There are 5 diagnostic criteria for multiple sclerosis based on:

(1) number of attacks

(2) number of lesions

(3) MRI findings

(4) CSF findings (oligoclonal bands not in serum or by raised IgG index)

(5) other clinical findings

 

Diagnostic options:

(1) multiple sclerosis – if one criteria is met, and there is no better explanation

(2) possible multiple sclerosis – if criteria are partially but not completely met, or if there is a better explanation

(3) not multiple sclerosis – if the criteria are not met

 

Clinical Presentation	Number of Lesions Based on Objective Findings	Other Findings Required
>= 2 attacks	>= 2	none
>= 2 attacks	1	group A below
1 attack	>= 2	group B below
1 attack	1	group C below
insidious progression		group D below

 

Group A - one or more of the following:

(1) dissemination in space by MRI based on criteria of Barkhof (above)

(2) >= 2 MRI-detected lesions consistent with MS AND positive CSF

(3) new clinical attack implicating a different site

 

Group B - one or more of the following:

(1) dissemination in time by MRI (above)

(2) second clinical attack

 

Group C – combination of the following:

(1) dissemination in space by MRI based on criteria of Barkhof (above)

(2) >= 2 MRI-detected lesions consistent with MS AND positive CSF

(3) dissemination in time by MRI (above)

(4) second clinical attack

 

where:

• This is the monosymptomatic presentation.

• The table says (1) OR (2) AND (3) OR (4), which can be parsed in 2 ways.

• Way 1: (1) OR ((2) AND (3)) OR (4)

• Way 2: ((1) OR (2)) AND ((3) OR (4))

• I selected Way 2 for the implementation based on my reading of the discussion on page 125.

 

Group D – combination of the following:

(1) positive CSF

(2) dissemination in space by MRI by one of the following:

(2a) >= 9 T2 lesions in brain, OR

(2b) >= 2 lesions in spinal cord, OR

(2c) 4-8 brain lesions + 1 spinal cord lesion

(3) abnormal visual evoked potential (VEP) associated with

(3a) 4-8 brain lesions, OR

(3b) 1-3 brain lesions with 1 spinal cord lesion

(4) dissemination in time by MRI

(5) continued progression for 1 year

 

where:

• The table says (1) AND (2) OR (3) AND (4) OR (5), which can be parsed in 2 ways.

• Way 1: (1) AND ((2) OR (3)) AND ((4) OR (5))

• Way 2: ((1) AND (2)) OR ((3) AND (4)) OR (5)

• I selected Way 1 for the implementation.