Revised McDonald Criteria for Multiple Sclerosis Diagnosis

Determines presence of MS using MRI findings.

Clinical Evidence

Number of attacks with objective clinical findings

  • Per Polman, et. al, 2010: "An attack is defined as a neurologic spaceturbance of the kind seen in MS. It can be documented by subjective report or by objective observation, but it must last for at least 24 hours. Pseudoattacks and single paroxysmal episodes must be excluded. To be considered separate attacks, at least 30 days must elapse between onset of one event and onset of another event."

Primary Progressive Multiple Sclerosis (PPMS) Criteria

One year of disease progression (retrospective or prospective)

Number of lesions with objective clinical evidence

Reasonable historical evidence of a prior attack

  • Per Polman, et. al, 2010: "Clinical diagnosis based on objective clinical findings for 2 attacks is most secure. Reasonable historical evidence for 1 past attack, in the absence of documented objective neurological findings, can include historical events with symptoms and evolution characteristics for prior inflammatory demyelinating even; at least 1 attack however must be supported by objective findings."

Are MRI result available

Dissemination in Space
Demonstrated by ≥1 T2 lesion in at least 2 of the following 4 CNS Regions

Periventricular T2 lesions

Juxtacordial T2 lesions

Infratentorial T2 lesions

Spinal Cord T2 lesion(s)

Dissemination in Time
Demonstrated by ≥1 of the following:

A new T2 and/or gadolinium-enhancing lesion on follow-up MRI, with reference to a baseline scan, irrespective of the timing of baseline scan.

Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time.

Positive CSF

  • Isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index


Source: Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2017.