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. 2015 Dec 1;52(Suppl 1):S1–S11. doi: 10.5152/npa.2015.12608

Table 9.

The 2005 revisions to the McDonald diagnostic criteria for multiple sclerosis (11)

Clinical presentation Additional data needed for MS diagnosis
Two or more attcaksa; objective clinical evidence of two or more lesions
Two or more attcaksa; objective clinical evidence of one lesion
One attacka; objective clinical evidence of two or more lesions
One attacka; objective clinical evidence of one lesion (monosymptomatic presentation; clinically isolated syndrome)
Insidious neurological progression suggestive of MS
Noneb
Dissemination in space, demonstrated by:
  • MRIc or

  • Two or more MRI-detected lesions consistent with MS plus positive CSFd or

  • Await further clinical attacka implicating a different site.

Dissemination in time, demonstrated by:
  • MRIe or

  • Second clinical attacka

Dissemination in space, demonstrated by:
  • MRIc or

  • Two or more MRI-detected lesions consistent with MS plus positive CSFd and

Dissemination in time, demonstrated by:
  • MRIe or

  • Second clinical attacka

One year of disease progression (retrospectively or prospectively determined) and
Two of the following:
  1. Positive brain MRI (nine T2 lesions or four or more T2 lesions with positive VEP)f

  2. Positive spinal cord MRI (two focal T2 lesions)

  3. Positive CSFd

If criteria indicated are fulfilled and there is no better explanation for the clinical presentation, the diagnosis is MS; if suspicious, but the criteria are not completely met, the diagnosis is “possible MS”; if another diagnosis arises during the evaluation that better explains the entire clinical presentation, then the diagnosis is “not MS.”

a

An attack is defined as an episode of neurological disturbance for which causative lesions are likely to be inflammatory and demyelinating in nature. There should be subjective report (backed up by objective findings) or objective observation that the event lasts for at least 24 hours.

b

No additional tests are required; however, if tests (MRI, CSF) are undertaken and are negative, extreme caution needs to be taken before making a diagnosis of MS. Alternative diagnoses must be considered. There must be no better explanation for the clinical picture and some objective evidence to support a diagnosis of MS.

c

MRI demonstration of space dissemination must fulfill the criteria in Table 10.

d

Positive CSF determined by oligoclonal bands detected by established methods (isoelectric focusing) different from any such bands in serum, or by an increased IgG index.

e

MRI demonstration of time dissemination must fulfill the criteria in Table 9.

F

Abnormal VEP of the type seen in MS.

MS: multiple sclerosis; MRI: magnetic resonance imaging; CSF: cerebrospinal fluid; VEP: visual-evoked potential.