Advances in the understanding of multiple sclerosis and the development of biomarkers of pathophysiology prompted a substantial revision of the 2017 McDonald diagnostic criteria. The new 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis in individuals with relapsing or progressive courses throughout the lifespan (ie, from paediatric to late-life presentations). The optic nerve can now serve as a fifth anatomical location within the CNS for diagnosis. The central vein sign, paramagnetic rim lesions, and kappa free-light chain concentrations in CSF can be used, when available, to provide supportive evidence and confer specificity for a diagnosis of multiple sclerosis in specific situations. In certain cases, radiologically isolated syndrome or neurological symptoms that do not constitute a clear attack or progression of disability can fulfil the criteria for a multiple sclerosis diagnosis. We also provide guidance for the diagnosis of multiple sclerosis in older individuals (≥50 years) and those with comorbidities. The 2024 revised criteria should expedite the diagnosis of multiple sclerosis, while maintaining specificity.
Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria / Montalban, Xavier; Lebrun-Frénay, Christine; Oh, Jiwon; Arrambide, Georgina; Moccia, Marcello; Pia Amato, Maria; Amezcua, Lilyana; Banwell, Brenda; Bar-Or, Amit; Barkhof, Frederik; Butzkueven, Helmut; Ciccarelli, Olga; Chataway, Jeremy; Cohen, Jeffrey A; Comi, Giancarlo; Correale, Jorge; Deisenhammer, Florian; Filippi, Massimo; Fiol, Julie; Freedman, Mark S; Fujihara, Kazuo; Granziera, Cristina; Green, Ari J; Hartung, Hans-Peter; Hellwig, Kerstin; Kappos, Ludwig; Kimbrough, Dorlan; Killestein, Joep; Lublin, Fred; Marignier, Romain; Ann Marrie, Ruth; Miller, Aaron; Otero-Romero, Susana; Ontaneda, Daniel; Ramanathan, Sudarshini; Reich, Daniel; Rocca, Maria A; Rovira, Àlex; Saidha, Shiv; Salter, Amber; Sastre-Garriga, Jaume; Saylor, Deanna; Solomon, Andrew J; Sormani, Maria Pia; Stankoff, Bruno; Tintore, Mar; Tremlett, Helen; Van Der Walt, Anneke; Viswanathan, Shanthi; Wiendl, Heinz; Wildemann, Brigitte; Yamout, Bassem; Zaratin, Paola; Calabresi, Peter A; Coetzee, Timothy; Thompson, Alan J. - In: LANCET NEUROLOGY. - ISSN 1474-4422. - 24:10(2025), pp. 850-865. [10.1016/s1474-4422(25)00270-4]
Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria
Moccia, Marcello;
2025
Abstract
Advances in the understanding of multiple sclerosis and the development of biomarkers of pathophysiology prompted a substantial revision of the 2017 McDonald diagnostic criteria. The new 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis in individuals with relapsing or progressive courses throughout the lifespan (ie, from paediatric to late-life presentations). The optic nerve can now serve as a fifth anatomical location within the CNS for diagnosis. The central vein sign, paramagnetic rim lesions, and kappa free-light chain concentrations in CSF can be used, when available, to provide supportive evidence and confer specificity for a diagnosis of multiple sclerosis in specific situations. In certain cases, radiologically isolated syndrome or neurological symptoms that do not constitute a clear attack or progression of disability can fulfil the criteria for a multiple sclerosis diagnosis. We also provide guidance for the diagnosis of multiple sclerosis in older individuals (≥50 years) and those with comorbidities. The 2024 revised criteria should expedite the diagnosis of multiple sclerosis, while maintaining specificity.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
