Diagnostic Criteria for Multiple Sclerosis (MS)
| Clinical Presentation | Additional Data Needed for MS Diagnosis |
|---|---|
| 2 or more attacks; objective clinical evidence of 2 or more lesions or objective clinical evidence of 1 lesion with reasonable historical evidence of a prior attack | None |
| 2 or more attacks; objective clinical evidence of 1 lesion | Dissemination in space, demonstrated by • ≥1 T2 lesion on MRI in at least 2 out of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) or • Await a further clinical attack implicating a different CNS site |
| 1 attack; objective clinical evidence of 2 or more lesions | Dissemination in time, 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 • Await a second clinical attack |
| 1 attack; objective clinical evidence of 1 lesion (clinically isolated syndrome) | Dissemination in space and time, demonstrated by: For dissemination in space • ≥1 T2 lesion in at least 2 out of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) or• Await a second clinical attack implicating a different CNS site andFor dissemination in time • 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 • Await a second clinical attack |
| Insidious neurologic progression suggestive of MS (PPMS) | 1 year of disease progression (retrospectively or prospectively determined) plus2 out of the 3 following criteria Evidence for dissemination in space in the brain based on ≥1 T2+ lesions in the MS-characteristic periventricular, juxtacortical, or infratentorial regions Evidence for dissemination in space in the spinal cord based on ≥2 T2+ lesions in the cord Positive CSF (isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index) |
Abbreviations: MS, multiple sclerosis; PPMS, primary progressive multiple sclerosis.
Source: From CH Polman et al: Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the “McDonald Criteria.” Ann Neurol 69:292, 2011.