Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

Summary The 2010 McDonald criteriafor the diagnosis of multiple sclerosisare widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosisreviewed the 2010 McDonald criteriaand recommended revisions. The 2017 McDonald criteriacontinue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil disseminationin time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of disseminationin space, the presence of CSF-specific oligoclonal bandsallows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate disseminationin space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate disseminationin space. Researchto further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.