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Neurology

2017 McDonald Criteria for Multiple Sclerosis calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

A better explanation than multiple sclerosis

If a better explanation exists, the diagnosis is not multiple sclerosis.

Course at onset
Clinical attacks

Count typical clinical attacks. A radiologically isolated syndrome without a clinical attack does not meet these criteria.

Objective clinical evidence of a lesion

Objective clinical evidence of how many central nervous system lesions are present. Historical evidence is entered separately.

Clear historical evidence of a prior lesion in a distinct site

Use this when a prior attack is clear and involved a lesion in a different anatomical site from the current objective lesion.

Periventricular lesion on MRI

Dissemination in space on MRI needs characteristic lesions in at least two of four regions: periventricular, cortical or juxtacortical, infratentorial, and spinal cord. The optic nerve is not one of the four regions. Symptomatic lesions count.

Cortical or juxtacortical lesion on MRI

Dissemination in space on MRI needs characteristic lesions in at least two of four regions: periventricular, cortical or juxtacortical, infratentorial, and spinal cord. The optic nerve is not one of the four regions. Symptomatic lesions count.

Infratentorial lesion on MRI

Dissemination in space on MRI needs characteristic lesions in at least two of four regions: periventricular, cortical or juxtacortical, infratentorial, and spinal cord. The optic nerve is not one of the four regions. Symptomatic lesions count.

Spinal cord lesion on MRI

Dissemination in space on MRI needs characteristic lesions in at least two of four regions: periventricular, cortical or juxtacortical, infratentorial, and spinal cord. The optic nerve is not one of the four regions. Symptomatic lesions count.

Clinical dissemination in space

Objective clinical findings already show lesions in two or more central nervous system sites, so MRI regions are not required to reach two.

MRI dissemination in time

Dissemination in time is simultaneous enhancing and non-enhancing lesions, a new T2 or enhancing lesion on follow-up MRI, or a further clinical attack.

A further clinical attack

Dissemination in time is simultaneous enhancing and non-enhancing lesions, a new T2 or enhancing lesion on follow-up MRI, or a further clinical attack.

CSF-specific oligoclonal bands

CSF-specific oligoclonal bands can stand in for dissemination in time once dissemination in space is shown. In progressive onset they are one of the three paraclinical findings.

One year of disability progression

Primary progressive multiple sclerosis requires one year of progression, independent of relapse.

Brain lesions characteristic of multiple sclerosis

One or more T2 lesions in at least one brain region characteristic of multiple sclerosis: periventricular, cortical or juxtacortical, or infratentorial.

At least two spinal cord lesions

At least two T2 lesions in the spinal cord, counted for progressive onset.

Result

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Clinical inputs

  • A better explanation than multiple sclerosis
  • Course at onset
  • Clinical attacks
  • Objective clinical evidence of a lesion
  • Clear historical evidence of a prior lesion in a distinct site
  • Periventricular lesion on MRI
  • Cortical or juxtacortical lesion on MRI
  • Infratentorial lesion on MRI
  • Spinal cord lesion on MRI
  • Clinical dissemination in space
  • MRI dissemination in time
  • A further clinical attack
  • CSF-specific oligoclonal bands
  • One year of disability progression
  • Brain lesions characteristic of multiple sclerosis
  • At least two spinal cord lesions

Primary source

Thompson AJ et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. DOI: 10.1016/S1474-4422(17)30470-2. PMID: 29275977. The table for an attack at onset, Panel 5 (MRI dissemination in space requires characteristic lesions in at least two of four regions: periventricular, cortical or juxtacortical, infratentorial, and spinal cord; dissemination in time is simultaneous enhancing and non-enhancing lesions or a new T2 or enhancing lesion on follow-up), and Panel 6 (one year of progression plus two of brain lesions, at least two spinal lesions, and CSF-specific oligoclonal bands). CSF-specific oligoclonal bands can substitute for dissemination in time after dissemination in space is shown. A better explanation means the diagnosis is not multiple sclerosis. An attack that does not meet the table is possible multiple sclerosis. (2018)

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