EAN 2025 | The impact of the new McDonald diagnostic criteria for MS
Marcello Moccia, MD, PhD, University of Naples Federico II, Naples, Italy, comments on the impact of the new McDonald diagnostic criteria for multiple sclerosis (MS). He highlights that it enables earlier diagnosis and a more individualized approach, allowing for faster treatment and better outcomes. This interview took place at the 11th Congress of the European Academy of Neurology (EAN 2025) in Helsinki, Finland.
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Transcript
I believe that we are seeing earlier diagnosis with every new set of criteria. With this set of criteria, we are also looking at a more individualized diagnosis. So basically, we are making the diagnosis of MS with the best tools in each specific case, and this speeds things up. Because depending on, for instance, on the very first MRI, on the availability of some specific sequences on the very first MRI, etc...
I believe that we are seeing earlier diagnosis with every new set of criteria. With this set of criteria, we are also looking at a more individualized diagnosis. So basically, we are making the diagnosis of MS with the best tools in each specific case, and this speeds things up. Because depending on, for instance, on the very first MRI, on the availability of some specific sequences on the very first MRI, etc., we can already make the diagnosis of MS at the first appointment. And I think this is a unique opportunity to get the best window for treatment, the best window for preventing long-term disability. So in that sense, I believe we will see the actual results in the long term on the trajectories of progression at population level. But definitely in the short term, this is making, to be honest, as a neurologist, my life easier. Because I know that the new framework for the diagnosis might look complex, but actually it’s more about finding the easiest way to make the diagnosis. And now we have multiple different ways of making the diagnosis of MS. And if you are able to find the best way to make the diagnosis in that specific case, this will speed things up. We are aware that changing the diagnostic criteria does not mean changing prescription criteria that are country-based and in some cases insurance-based. So we cannot change that. But definitely incorporating new tools that can provide strong prognostic value means that we will be able to predict the trajectory of the disease way before than we did in the past. If we think about 20 years ago, it was said that the prediction of the trajectory was within two or three years from the time of diagnosis. Now at the time of diagnosis we already have a huge amount of information that can provide very strong prognostic information and in that sense I believe that we will improve treatment decisions on some specific measures, so for instance, paramagnetic rim lesions – to be honest, we don’t know exactly what medications work, we will know in the future, so hopefully we will make much more individualized decisions in MS than we did in the past.
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