Forum

IMPORTANT CHANGES TO McDONALD CRITERIA FOR DIAGNOSING MS

Hi all. Some changes have been approved to the revised McDonald criteria for diagnosing MS. THESE ARE VERY RELEVANT FOR ANYONE IN LIMBO!!! Basically, there still needs to be dissemination in time and in space, but the number of lesions required to get a diagnosis has been reduced massively and they will now accept evidence of previous attacks (even if this is the patient’s own recollection!). Here is the official stuff: Immediate diagnosis of MS if you have had: 2 attacks and there is objective clinical evidence of at least 2 lesions OR objective clinical evidence of 1 lesion with reasonable historical evidence of a prior attack. (MRI, LP, VEPs etc are still not required, as is the previous version, but most neuros will do it anyway I would guess. “Reasonable” means that they may accept patient’s own report of previous attacks.) When someone satisfies dissemination in time, but not space, i.e. if you have had at least 2 attacks and there is objective clinical evidence of 1 lesion. Diagnosis of MS when dissemination in space is demonstrated by: more than 1 T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) OR a further clinical attack implicating a different CNS site. When someone satisfies dissemination in space, but not time: i.e. if you have had at least 1 attack and there is objective clinical evidence of at least 2 lesions. Diagnosis of MS when dissemination in time is demonstrated by: Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time; or a new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or a second clinical attack. When someone satisfies neither dissemination in time nor space, i.e. if you have had 1 attack and there is objective clinical evidence of 1 lesion. Diagnosis of clinically isolated syndrome (CIS). Diagnosis of MS when dissemination in space and time is demonstrated by: - At least 1 T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) or a second clinical attacka implicating a different CNS site; AND - Simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan; or a second clinical attack. Diagnosis of PPMS when there is 1 year of disease progression (retrospectively or prospectively determined) plus 2 of 3 of the following criteria: 1. Evidence for dissemination in space in the brain based on at least 1 T2 lesions in the MS-characteristic (periventricular, juxtacortical, or infratentorial) regions. 2. Evidence for dissemination in space in the spinal cord based on at least 2 T2 lesions in the cord. 3. Positive CSF (isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index) [i.e. positive LP]. I’ll try and answer questions if anyone has any, but you can google Polman et al. “Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria”. ANN NEUROL 2011;69:292–302. The paper is free to download. THIS IS EXCITING NEWS FOR ANYONE IN LIMBO!!! Karen x

hello,havn’t been back long,with new site,and new threrapy with cbt management fatigue with rest periods,but i too am wm,and i went privtaley to see dr martin ms pspecialist in gloucester,can’t sing his praises enough,he is so understanding,gives youtime,listens,and is so thorough,i went privatley,he then refered me through to gloucester,as yet not enough evidence,but he is perscribing symtom treatment and cbt,and havn’t just been discharged,nothing to loose,only to gain ,i do hope this helps you and he can help you through this diffivult time , love boz xxx

:stuck_out_tongue: hi karen, so interesting reading through new rivised criteria,my lesions are periventricular,could it possiablye me ,havn’t been on for a while,getting used to new site,i am presently going through four cbt sessions,with psychologists referefal through dr martion,to neurologiacal conditions,i have just throroughly recomended ,dr martin ,he is so understanding to ms problems,i do hope it will help.i have been told who knows with diagnoses 5years 10 years who knows,but at least i feel beleived,and talked through listening to everything,and being told to accept it,and learning to mange rest periods,not to over exaust myself and bring about flareups.i wait in hope,but also relived to be still with dr martin,i am so happy i went privatley to see him. wishing you well. love bozxxx :stuck_out_tongue:

Hi Boz :slight_smile: Glad you’re getting some support :). It makes the world of difference to know that the medics believe us! Periventricular lesions are very common in MS (some neuros don’t like to diagnosis MS without them), but you would normally need at least one lesion somewhere else too to get that elusive diagnosis. One day eh?! Karen x

hi karen,i have not been on for awhile,but realluy i did,and found your post,how i hope with a diagnoses,going through a diary with cbt,to help find more rest periods,feeling not so good at the moment,like a flare up,evrything feeling charged up,and more prominant,have diazapham for back ,and spasms on waking,usually go up gaabapentin,then back down,but rough period.i truly truly hope my one comes,my psychologist says,one day i may get a dianoses too,so i am praying,started diary 16thsep for 2 weeks,then go back to see her for two sessions,then back to see dr martin,and review spine mri,ever hopeful,thankyou for your post .hope you are keeping well, love bozxxx :wink: :wink:

Hi Boz :slight_smile: Sorry to hear you’re not so good :frowning: I hope it doesn’t last too long. Can your GP help with different meds, if the ones you’re on aren’t quite doing the trick? Good luck with the spinal MRI appointment - let me know what happens! Karen x