Mcdonald_ms_2017_guideline v.1

Mcdonald criteria for multiple sclerosis (2017 revision) diagnoses multiple sclerosis.

Maryam Razavi

maryam.razavi@cambio.se

Cambio CDS

To assist clinicians to diagnose multiple sclerosis.

Variables: - Clinical attacks: Must have ≥1 clinical attack Number of clinical attacks: (“Clinical attack” = monophasic clinical episode with patient-reported symptoms and objective findings reflecting inflammatory demyelinating CNS event (focal or multifocal), subacute or acute, for ≥24 hrs, with or without recovery, and no fever or infection present; attack, relapse, exacerbation, and clinically isolated syndrome (first episode) are all synonymous) - Lesions: Must have ≥1 lesion: Number of lesions with objective clinical evidence: (“Objective clinical evidence” = abnormality on neurologic exam, imaging (MRI or optical coherence tomography), or visual evoked potentials, corresponding to anatomical location suggested by symptoms) - Historical evidence of a previous attack involving a lesion in a distinct anatomical location (Yes, No) Additional data: (Yes, No) - Dissemination in time demonstrated by additional clinical attack or MRI, or presence of CSF-specific oligoclonal bands - Dissemination in space demonstrated by an additional clinical attack implicating a different CNS site or by MRI Interpretation (Definite MS or Not MS): Clinical attacks≥2 AND Number of lesions with objective clinical evidence ≥2 THEN Definite MS. Clinical attacks=1 AND Number of lesions with objective clinical evidence =1 AND DIT=Yes AND DIS=Yes THEN Definite MS. Clinical attacks ≥2 AND Number of lesions with objective clinical evidence =1 AND Historical evidence of a previous attack=Yes THEN Definite MS. Clinical attacks ≥2 AND Number of lesions with objective clinical evidence =1 AND Historical evidence of a previous attack=No AND DIS=Yes THEN Definite MS. Clinical attacks =1 AND Number of lesions with objective clinical evidence ≥2 AND DIT=Yes THEN Definite MS.

Not to be used to differentiate MS from other conditions.

1. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintoré M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-173. doi: 10.1016/S1474-4422(17)30470-2. Epub 2017 Dec 21. PMID: 29275977.

OBSERVATION.mcdonald_criteria_for_ms.v0