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L6: McDonald criteria 2010: making the diagnosis easier

L6: McDonald criteria 2010: making the diagnosis easier
  • Neurology

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McDonald criteria 2010: making the diagnosis easier A.J. Thompson

A.J. Thompson 

Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery Queen Square, London, UK

The diagnosis of MS remains firmly based on clinical evaluation and the essential need to provide evidence for dissemination in time and space and, importantly, to exclude other neurological conditions that could cause similar symptoms. While investigations are important to exclude other conditions, the interpretation of their results will only be as good as the clinical premise on which they are based. The evolution of diagnostic criteria since Poser in 1983 has focused on improved definition and greater precision. The introduction of magnetic resonance imaging (MRI) has had a major impact on both the timing and accuracy of diagnosis. The initial McDonald criteria (2000) incorporated MRI for the first time and were very cautious in order to maximise specificity. They incorporated the Barkhof criteria to determine dissemination in space and time, but these criteria are complex, and not easily applied. Criteria for primary progressive MS (PPMS) were distinct and had even less evidence base.

The subsequent revisions of the McDonald criteria in 2005 and 2010 simplified the MRI criteria for dissemination in both time and space, based on sound studies, reduced the emphasis on cerebrospinal fluid findings in PPMS and drew more closely together the criteria for the relapsing and progressive forms of the condition. In addition, the recent 2010 version, addresses, for the first time, the complexities of neuromyelitis optica and the spectrum of related disorders, in addition to the topical issue of paediatric MS

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