The ECTRIMS 2024 meeting dedicated a session to the draft revision of the McDonald diagnostic criteria for MS. This is an initiative of the International Advisory Committee on Clinical Trials in MS, presided by Prof. Xavier Montalban (Vall d'Hebron University Hospital, Spain). He presented the most important upcoming revisions of the 2017 version of the McDonald criteria [1,2].
The first and most fundamental change Prof. Montalban mentioned, was that RIS is considered MS in specific situations. This allows for diagnosing MS in asymptomatic individuals. “This means we are moving towards a biological diagnosis, which is happening as well in other neurodegenerative conditions such as Alzheimer's and Parkinson's disease.”
The other proposed revisions include the following:
- The optic nerve may serve as a fifth anatomical location to demonstrate dissemination in space (DIS) —assessed by MRI, visual evoked potential, or optical coherence tomography— if no better explanation for topic nerve pathology can be found.
- DIT is no longer required.
- DIS criteria have been updated: DIS criteria are fulfilled when 2 out of 5 topographies show typical lesions, whether these are symptomatic or not.
- Kappa-free light chain (kFLC) is a diagnostic marker for MS.
- Criteria for diagnosing primary progressive MS and relapsing MS are now the same.
- Paraclinical evidence is needed to diagnose MS.
- Stricter features should be used to diagnosis MS in individuals >50 years of age, with headache disorders (including migraine), or with vascular disorders.
- Central vein sign (CVS) and a paramagnetic rim lesion (PRL) are added as optional tools to help diagnose MS in certain situations.
- Laboratory tests (e.g. MOG-IgG-Ab) are recommended to confirm the diagnosis in children and adolescents.
- Montalban X. Revised McDonald criteria 2023. Scientific Session 1, ECTRIMS 2024, 18–20 September 2024, Copenhagen, Denmark.
- Thompson AJ, et al. Lancet Neurol. 2018;17(2):162-73.
Medical writing support was provided by Michiel Tent
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