McDonald criteria

The McDonald criteria are diagnostic criteria for multiple sclerosis (MS). These criteria are named after neurologist W. Ian McDonald. In April 2001, an international panel in association with the National Multiple Sclerosis Society (NMSS) of America recommended revised diagnostic criteria for MS. They have undergone revisions in 2005 and 2010. These new criteria intended to replace the Poser criteria and the older Schumacher criteria. They discourage the previously used Poser terms such as "clinically definite" and "probable MS", and propose as diagnostic either "MS", "possible MS", or "not MS".

The McDonald criteria maintained a scheme for diagnosing MS based solely on clinical grounds but also proposed for the first time that when clinical evidence is lacking, magnetic resonance imaging (MRI) findings can serve as surrogates for dissemination in space (DIS) and/or time (DIT) to diagnose MS. The criteria try to prove the existence of demyelinating lesions, by image or by their effects, showing that they occur in different areas of the nervous system (DIS) and that they accumulate over time (DIT). The McDonald criteria facilitate the diagnosis of MS in patients who present with their first demyelinating attack and significantly increase the sensitivity for diagnosing MS without compromising the specificity.

The McDonald criteria for the diagnosis of multiple sclerosis were revised first in 2005 to clarify exactly what is meant by an "attack", "dissemination" and a "positive MRI", etc. Later they were revised again in 2010.

McDonald's criteria are the standard clinical case definition for MS and the 2010 version is regarded as the gold standard test for MS diagnosis.

Two of the following:

They discourage the previously used terms such as "clinically definite" and "probable MS", and propose as diagnostic either "MS", "possible MS", or "not MS".

Pathology is generally regarded as the gold standard in defining different forms of inflammatory demyelinating diseases.

Specificity of the McDonald criteria is low due to the fact that the nature of the lesions is not considered, but only their dissemination. None of the criteria are MS-specific. In order to reduce false positives, McDonald et al. propose that their criteria should be applied only after any other disease has been ruled out. In 2008 a consensus was developed for differential diagnosis.

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