What is the MacDonald criteria for the diagnosis of multiple sclerosis?

The MacDonald criteria for the diagnosis of multiple sclerosis (2011)

There are 5 possible scenarios as clinical presentations. Besides the clinical presentation, some additional pieces of evidence are required for the diagnosis of multiple sclerosis 

Scenario no 01

Clinical presentation: 
Two or more attacks with either objective clinical evidence of at least 2 lesions or Objective clinical evidence of 1 attack with reasonable evidence (on clinical history) of at least 1 prior attack
Additional evidence required for the diagnosis of MS: 
None i.e. no other pieces of evidence are required

Scenario no 02
Clinical presentation: 
Two or more attacks with objective clinical evidence of 1 lesion 
Additional evidence required for the diagnosis of MS: 
Dissemination in 'space ' demonstrated by magnetic resonance imaging (MRI) ≥ 1 lesion in at least 2 Of the MS-typical regions' (multiple lesions in different sites) or
Await further clinical attack at a different anatomical site 

Scenario no 03

Clinical presentation: 
One attack with objective clinical evidence of ≥ 2 lesions 
Additional evidence required for the diagnosis of MS: 
Dissemination in 'time ' demonstrated by evolving MRI showing combined enhancing (new) and non-enhancing (old) lesions, or 
New T2 or enhancing lesion on repeat MRI, or 
Await further (second) clinical attack at a different anatomical site 

Scenario no 04

Clinical presentation: 
One attack with clinical evidence of only 1 lesion (clinically isolated syndrome) 
Additional evidence required for the diagnosis of MS: 
Dissemination in 'space ' demonstrated by ≥1 T2 lesion in at least 2 MS-typical regions, or 
Dissemination in 'time demonstrated by simultaneous enhancing and non-enhancing lesions or 
New T2 or enhancing lesions on repeat MRI or 
Await further (second) clinical attack 

Scenario no 05

Clinical presentation: 
Insidious neurological progression suggestive of MS 
Additional evidence required for the diagnosis of MS: 
1 year of progression plus 2 Of the following: 
  • Evidence for dissemination in space with ≥1 T2 lesion in MS-typical regions 
  • Evidence for dissemination in space based on ≥2 lesions in the spinal cord 
  • Positive cerebrospinal fluid (evidence of oligoclonal band and/or elevated immunoglobulin G index) 

Attention:
If there is a complete association between two steams of anyone out of 5 scenarios (clinical plus evidence), the diagnosis is MS. 

If there is an incomplete association, the diagnosis is 'possible MS'. 

Other possible causes for central nervous system inflammation (e.g. sarcoidosis, systemic lupus erythematosus) have to be excluded.

MS-typical regions= periventricular, juxtacortical, infratentorial, spinal cord. 

[Source: Davidson's principles and practice of medicine 23rd Edition; page 1107]

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