The McDonald criteria are diagnostic criteria for multiple sclerosis. In April 2001 an international panel in association with the National Multiple Sclerosis Society (NMSS) of America recommended revised diagnostic criteria for ms. They make use of advances in MRI imaging techniques and are intended to replace the Poser criteria and the older Schumacher criteria. The new criteria facilitate the diagnosis of MS in patients who present with signs and symptoms suggestive of the disease. These include monosymptomatic disease, disease with a typical relapsing-remitting course or insidious progression but no clear attacks and remissions.
Additional recommended knowledge
The McDonald criteria for the diagnosis of multiple sclerosis were revised in 2005 to clarify exactly what is meant by an "attack," "dissemination," a "positive MRI," etc (Polman et al 2005).
Diagnostic Criteria
| Clinical Presentation
| Additional Data Needed
|
* 2 or more attacks (relapses)
* 2 or more objective clinical lesions
| None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
|
* 2 or more attacks
* 1 objective clinical lesion
| Dissemination in space, demonstrated by:
* MRI
* or a positive CSF and 2 or more MRI lesions consistent with MS
* or further clinical attack involving different site
|
* 1 attack
* 2 or more objective clinical lesions
| Dissemination in time, demonstrated by:
* MRI
* or second clinical attack
|
* 1 attack
* 1 objective clinical lesion
(monosymptomatic presentation)
| Dissemination in space by demonstrated by:
* MRI
* or positive CSF and 2 or more MRI lesions consistent with MS
and
Dissemination in time demonstrated by:
* MRI
* or second clinical attack
|
Insidious neurological progression
suggestive of MS
(primary progressive MS)
| Positive CSF
and
Dissemination in space demonstrated by:
* MRI evidence of 9 or more T2 brain lesions
* or 2 or more spinal cord lesions
* or 4-8 brain and 1 spinal cord lesion
* or positive VEP with 4-8 MRI lesions
* or positive VEP with <4 brain lesions plus 1 spinal cord lesion
and
Dissemination in time demonstrated by:
* MRI
* or continued progression for 1 year
|
References
- McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis.". Ann Neurol 50 (1): 121-7. PMID 11456302.
- Polman CH, Reingold SC, Edan G, Filippi M, Hartung HP, Kappos L, Lublin FD, Metz LM, McFarland HF, O'Connor PW, Sandberg-Wollheim M, Thompson AJ, Weinshenker BG, Wolinsky JS (2005). "Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"". Ann Neurol 58 (6): 840-6. PMID 16283615.
| Nervous system pathology, primarily CNS (G00-G47, 320-349) |
|---|
Inflammatory diseases
of the CNS | Meningitis (Arachnoiditis) - Encephalitis - Myelitis - Encephalomyelitis (Acute disseminated) - Tropical spastic paraparesis |
|---|
Systemic atrophies
primarily affecting the CNS | Huntington's disease - Spinocerebellar ataxia (Friedreich's ataxia, Ataxia telangiectasia, Hereditary spastic paraplegia)
Spinal muscular atrophy: Werdnig-Hoffman disease - Kugelberg-Welander disease - Fazio Londe syndrome -
MND (Amyotrophic lateral sclerosis (ALS), Progressive muscular atrophy (PMA), Progressive bulbar, Pseudobulbar, PLS) |
|---|
Extrapyramidal and
movement disorders | Parkinson's disease - Neuroleptic malignant syndrome - Postencephalitic parkinsonism - Pantothenate kinase-associated neurodegeneration - Progressive supranuclear palsy - Striatonigral degeneration - Dystonia (Spasmodic torticollis, Meige's syndrome, Blepharospasm) - Essential tremor - Myoclonus - Chorea (Choreoathetosis) - Restless legs syndrome - Stiff person syndrome |
|---|
Other degenerative /
demyelinating diseases | Alzheimer's disease - Pick's disease - Alpers' disease - Dementia with Lewy bodies - Leigh's disease - Multiple sclerosis - Devic's disease - Central pontine myelinolysis - Transverse myelitis |
|---|
| Seizure/epilepsy | Focal (Simple partial, Complex partial) - Generalised (Tonic-clonic, Absence, Atonic, Benign familial neonatal) - Lennox-Gastaut - West - Epilepsia partialis continua - Status epilepticus (Complex partial status epilepticus) |
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| Headache | Migraine (Familial hemiplegic) - Cluster - Vascular - Tension |
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| Vascular | Transient ischemic attack (Amaurosis fugax, Transient global amnesia) - Cerebrovascular disease (MCA, ACA, PCA, Foville's syndrome, Millard-Gubler syndrome, Lateral medullary syndrome, Weber's syndrome, Lacunar stroke) |
|---|
| Sleep disorders | Insomnia - Hypersomnia - Sleep apnea (Ondine's curse) - Narcolepsy - Cataplexy - Kleine-Levin syndrome - Circadian rhythm sleep disorder - Delayed sleep phase syndrome - Advanced sleep phase syndrome |
|---|
| Other | Hydrocephalus (Normal pressure) - Idiopathic intracranial hypertension - Encephalopathy - Brain herniation - Cerebral edema - Reye's syndrome - Syringomyelia - Syringobulbia - Spinal cord compression |
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