Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria.
Montalban Xavier, Lebrun-Frénay Christine, Oh Jiwon, Arrambide Georgina, Moccia Marcello, Pia Amato Maria, Amezcua Lilyana, Banwell Brenda, Bar-Or Amit, Barkhof Frederik
AI Summary
The 2024 McDonald criteria unify MS diagnosis across ages, with the optic nerve now a fifth CNS location, potentially expediting diagnosis while maintaining specificity.
Abstract
Advances in the understanding of multiple sclerosis and the development of biomarkers of pathophysiology prompted a substantial revision of the 2017 McDonald diagnostic criteria. The new 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis in individuals with relapsing or progressive courses throughout the lifespan (ie, from paediatric to late-life presentations). The optic nerve can now serve as a fifth anatomical location within the CNS for diagnosis. The central vein sign, paramagnetic rim lesions, and kappa free-light chain concentrations in CSF can be used, when available, to provide supportive evidence and confer specificity for a diagnosis of multiple sclerosis in specific situations. In certain cases, radiologically isolated syndrome or neurological symptoms that do not constitute a clear attack or progression of disability can fulfil the criteria for a multiple sclerosis diagnosis. We also provide guidance for the diagnosis of multiple sclerosis in older individuals (≥50 years) and those with comorbidities. The 2024 revised criteria should expedite the diagnosis of multiple sclerosis, while maintaining specificity.
MeSH Terms
Shields Classification
Key Concepts5
The 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis in individuals with relapsing or progressive courses throughout the lifespan (ie, from paediatric to late-life presentations).
The optic nerve can now serve as a fifth anatomical location within the CNS for the diagnosis of multiple sclerosis according to the 2024 McDonald criteria.
The central vein sign, paramagnetic rim lesions, and kappa free-light chain concentrations in CSF can be used, when available, to provide supportive evidence and confer specificity for a diagnosis of multiple sclerosis in specific situations, as per the 2024 McDonald criteria.
In certain cases, radiologically isolated syndrome or neurological symptoms that do not constitute a clear attack or progression of disability can fulfil the criteria for a multiple sclerosis diagnosis under the 2024 McDonald criteria.
The 2024 revised McDonald criteria provide guidance for the diagnosis of multiple sclerosis in older individuals (≥50 years) and those with comorbidities.
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