2010 Revised McDonald Criteria for Multiple Sclerosis calculator

Clinical inputs

• A better explanation than multiple sclerosis
• Onset
• Attacks
• Objective clinical lesions
• Reasonable historical evidence of a prior attack at another site
• Periventricular T2 lesion
• Juxtacortical T2 lesion
• Infratentorial T2 lesion
• Spinal cord T2 lesion
• Clinical dissemination in space
• MRI dissemination in time
• A second clinical attack
• Positive cerebrospinal fluid
• One year of progression
• Two or more spinal T2 lesions

Primary source

Polman CH et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. DOI: 10.1002/ana.22366. PMID: 21387374. Table 1: dissemination in space is at least one T2 lesion in at least two of four areas (periventricular, juxtacortical, infratentorial, spinal cord). Gadolinium enhancement is not required. A symptomatic brainstem or spinal cord lesion is excluded from the count. Table 2: dissemination in time is a new T2 or gadolinium-enhancing lesion on follow-up, whatever the timing of the baseline scan, or simultaneous asymptomatic gadolinium-enhancing and nonenhancing lesions. Table 3: primary progressive disease needs one year of progression plus two of brain dissemination (≥1 T2 lesion in at least one of periventricular, juxtacortical, or infratentorial), ≥2 spinal T2 lesions, and positive CSF (oligoclonal bands on isoelectric focusing and/or an elevated IgG index). Table 4: two attacks with two objective lesions, or one objective lesion plus reasonable historical evidence of a prior attack, meet the diagnosis with no further data. Two attacks and one objective lesion need dissemination in space or a later attack in a different site. One attack and at least two objective lesions need dissemination in time or a second attack. One attack and one objective lesion need both dissemination in space and dissemination in time. A better explanation is not multiple sclerosis. Suspicious disease that does not meet the table is possible multiple sclerosis. Positive CSF does not replace dissemination in time after an attack. (2011)