EAN 2025 | The recent revision of the McDonald criteria for MS diagnosis
Marcello Moccia, MD, PhD, University of Naples Federico II, Naples, Italy, comments on the recent revision of the McDonald criteria for the diagnosis of multiple sclerosis (MS). He highlights the incorporation of new diagnostic tools, including cerebrospinal fluid (CSF) analysis, MRI techniques, and clinical presentation, which provide valuable insights into the mechanisms, prognosis, and profiling of individuals with MS. This interview took place at the 11th Congress of the European Academy of Neurology (EAN 2025) in Helsinki, Finland.
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Transcript
So the new McDonald’s criteria, the very recent revision of the criteria, provides huge changes to the way we make the diagnosis of MS and also provides some very important insights on the mechanisms of MS and so on the prognosis and profiling of individuals with MS. In this sense, we have new definitions of dissemination in space with the incorporation of a new typical region of MS lesions, which is the optic nerve that adds up to juxtacortical, periventricular, infratentorial and spinal cord lesions...
So the new McDonald’s criteria, the very recent revision of the criteria, provides huge changes to the way we make the diagnosis of MS and also provides some very important insights on the mechanisms of MS and so on the prognosis and profiling of individuals with MS. In this sense, we have new definitions of dissemination in space with the incorporation of a new typical region of MS lesions, which is the optic nerve that adds up to juxtacortical, periventricular, infratentorial and spinal cord lesions. We also incorporate the historical definition of dissemination in time, but basically we update definitions of dissemination in time so that they can be replaced with newer tools, including the CSF. And by CSF, we mean a positivity to the CSF that includes both oligoclonal bands and kappa-free light chain index, and new MRI tools that include the central vein sign and, in some specific cases, paramagnetic rim lesions. Among these tools, paramagnetic rim lesions and the Kappa-Free Light Chain Index provide very important information on the risk of progression of people with MS. That means that by incorporating these tools, we have a very good window on the most detrimental aspects of MS pathology that can be used at the time of diagnosis to predict the progression, the risk of relapses, so to individualize the treatments and the management of individuals with MS. We are also including a definition of biological MS. This is completely new in the world of MS. And if we think of previous definitions of MS, they always had some clinical aspects. In this case, we keep clinical aspects and the clinical presentation or the lack of clinical presentation is the modality to make the very first point to make the diagnosis. But depending on what is your modality of clinical presentation, then the diagnosis can be made differently. And in some specific cases, we can also make the diagnosis of MS in the absence of clinical symptoms or in the presence of symptoms that are not specific of MS, but very typical of MS. We also believe this is the acknowledgement that some symptoms such as fatigue in MS are very important in the management of people with MS and now can be also the very first point to make the diagnosis of MS.
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