The McDonald Criteria, used for the diagnosis of multiple sclerosis (MS), has been revised by a 30-member international panel of MS experts co-chaired by Jeffrey Cohen, MD (Cleveland Clinic) and Alan Thompson, MD (University College London). The new recommended revisions are expected to speed the diagnostic process and reduce the chance of misdiagnosis.
The panel was convened under the auspices of the International Advisory Committee on Clinical Trials in MS and they published their findings in The Lancet Neurology online on 21 December 2017.
Multiple sclerosis can be difficult to diagnose because there is no single test that can determine that a person has MS. The process of diagnosis involves obtaining evidence from a clinical examination, medical history, lab tests and MRI imaging of the brain and sometimes the spinal cord. These tests are intended to rule out other possible causes of a person's neurological symptoms and to gather data consistent with MS.
The McDonald Criteria was last reviewed in 2010, so the panel looked at prior diagnostic criteria and evidence published since the last review to help inform evidence-based recommendations likely to speed the diagnostic process and reduce the incidence of misdiagnosis.
The panel recommended
Key things that haven't changed
Key changes for patients with clinically isolated syndrome (CIS)
Recent studies suggest misdiagnosis of MS is not uncommon. The paper emphasises that if an individual does not have typical CIS, or is a member of a population in which MS is less common (such as children, older individuals, or non-white populations), additional testing can help gather additional evidence needed to firm up whether the person indeed has MS or something else that may require different treatment and management.
Anyone who was diagnosed using previous versions of the McDonald Criteria will still meet the criteria for MS as laid out in the 2017 McDonald Criteria.
The panel recommended that the 2017 McDonald Criteria be validated in a variety of studies and populations, and that research continue on biomarkers, imaging and other advances that may help refine the diagnostic process in the future.
Bruce Bebo, PhD, Executive Vice President of Research at the National MS Society, said: “The paper highlights the need for research to identify additional biological markers of MS and its subtypes. This gap impedes progress on several fronts, making it a critical target for the global MS research community.”