ECTRIMS 2025 | Paraclinical tests incorporated in the updated McDonald diagnostic criteria for MS

So the new criteria for the diagnosis of MS have incorporated different new paraclinical tools. First of all, there is the possibility of studying the optic nerve using orbital MRI, OCT or visual evoked potentials. And also there is the possibility of further characterizing brain lesions using some specific iron-sensitive sequences with the detection of the central vein sign and paramagnetic rim lesions. And also the CSF analysis is not only oligoclonal bands, but it’s also kappa-free light chains for the calculation of the kappa-free light chain index. So, to some extent, it might look like the diagnosis of MS is much more complicated, but it’s actually much more flexible. So it’s not a matter of the tools. We have many different ways to make the diagnosis, thanks to the new criteria. And the point is not doing all the available tests, but it’s selecting the best test in each case. Of course, the selection needs to be guided by the clinical presentation, by the possible differentials. So at the very end, you run what is most sensible to do in each specific case. This gives a lot of flexibility to the diagnosis of MS. And if well implemented, can actually speed up the diagnosis, can reduce the rate of misdiagnosis, and can also improve prognostication. Because many of these tools can actually be used also for prognosis of MS. So definitely we are incorporating new tools that initially might look sort of complicated to implement, but at the very end I think they can make the difference, not only in the diagnosis, but also in the management of people with MS.

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