….and on that Criteria he had some neuros….Ee,i, ee,i, o with some consultancy here (This week Barcelona) and some consultancy there (Next year SanDiego), here, there, here, there, every where a……
So the McDonald Criteria for MS diagnosis has truly dropped only 2 years after it was first leaked. This means it is easier to diagnose MS and get people onto treatment earlier. It’s release has been timed for ECTRIMS 2025 no doubt….So all Neuros can learn it when they go to Barcelona next week.
A consensus conference (Nov 29–Dec 2, 2023, in Barcelona, Spain) brought together 56 contributors, with a broad representation of expertise in neurology, neuroradiology, neuro-ophthalmology, laboratory testing, clinical management, and epidemiology, and people with lived experience of multiple sclerosis. The conference included 32 members of the Committee and additional contributors from several countries with high-resource, mid-resource, or low-resource settings.
These details were leaked at the Menactrims 2023 and posted on the Blog on Christmas Day 2023 and moved to New Years day 2024. Now the paper surfaces
The man from Barcelona is at the helm
p850. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria Xavier Montalban, et al.The Lancet Neurology, Volume 24, Issue 10, 850 – 865
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.
Disseminationa in Time (DIT. Lesions at more than one time) and Dissemination in Space (DIS lesions in different places) are hallmarks of diagnosis. With imaging DIT can be seen at a single time point and is no longer considered essential to incorporate into the criteria
DIS can be fulfilled when at least two of five regions (eg, juxtacortical or cortical, periventricular, infratentorial brain, spinal cord, and optic nerve) have typical lesions, regardless of whether these lesions are symptomatic. Multiple sclerosis can be diagnosed after showing DIS plus DIT on MRI or CSF-restricted oligoclonal bands or kappa free-light chains
So from 2017 to 2024 there have been changes in the criteria
Moccia M, Ciccarelli O, Thompson A. Implementation of the 2024 revision of the McDonald criteria for multiple sclerosis. Nat Rev Neurol. 2025 Sep 17. doi: 10.1038/s41582-025-01141-3. NB. In the interests of Balance ProfT reports no conflicts of interest
Solomon AJ, Brodersen JB. The 2024 revisions of the McDonald criteria pose risk of multiple sclerosis overdiagnosis. Nat Rev Neurol. 2025 Sep 17. doi: 10.1038/s41582-025-01140-4.
Tremlett H. The multiple sclerosis prodrome: insights into how and when disease starts. Nat Rev Neurol. 2025 . doi: 10.1038/s41582-025-01144-0.
Pappolla A, Arrambide G, Montalban X. A paradigm shift away from dissemination in time in multiple sclerosis. Nat Rev Neurol. 2025 Sep 17. doi: 10.1038/s41582-025-01138-y.
With MRI you can see the lesions are different ages so you only need a scan to see this
Deisenhammer F, Hegen H, Arrambide G, Banwell BL, Coetzee T, Gnanapavan S, Montalban X, Tumani H, Willrich MA, Freedman MS. Positive cerebrospinal fluid in the 2024 McDonald criteria for multiple sclerosis. EBioMedicine. 2025:105905. doi: 10.1016/j.ebiom.2025.105905.
The 2024 McDonald diagnostic criteria for Multiple Sclerosis (MS) introduce kappa free light (antibody) chains (κ-FLC) detection in cerebrospinal fluid (CSF) which can be used interchangeably with oligoclonal IgG bands (OCB) to demonstrate intrathecal immunoglobulin synthesis. (Oligoclonal bands need more experimental work to show). Diagnostic sensitivity (true positives) and specificity (lack of false positives) of κ-FLC is equal to OCB on a 95% confidence level. In rare cases determination of both, κ-FLC and OCB should be considered as the concordance rate is around 90%. We recommend calculating the κ-FLC index with values of ≥6.1 performing best for diagnosing MS…..There is some prognostic use of the κ-FLC index with higher values predicting higher disease activity. Neurofilament light (NfL) should not be used for diagnostic purposes although it might be useful for prognosis and disease monitoring. (Neurofilament is yet to be primetime) All recommendations apply to paediatric and adult relapsing as well as progressive onset MS.
COI None for me
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Source: multiple-sclerosis-research.org