Table 1

Diagnostic criteria for multiple sclerosis

Clinical presentationAdditional data needed for MS diagnosis
Relapse/attack at onset
 ≥2 clinical attacks and ≥2 lesions with objective clinical evidenceNone
 ≥2 clinical attacks and one lesion plus historical evidence of attack in different locationNone
 ≥2 clinical attacks and evidence of 1 lesion with objective clinical evidenceDissemination in space—demonstrated by an additional clinical attack implicating a different CNS site or by MRI*
 One clinical attack and ≥2 lesions with objective clinical evidenceDissemination in time—demonstrated by an additional clinical attack or by MRI† or demonstration of CSF-specific oligoclonal bands‡
 One clinical attack and one lesion with objective clinical evidenceDissemination in space—demonstrated by an additional clinical attack implicating a different CNS site or MRI*
AND
Dissemination in time—demonstrated by an additional clinical attack or MRI† or demonstration of CSF-specific oligoclonal bands‡
Progression at onset
Progression from onset
(primary progressive MS)
1 year of disability progression (retrospectively or prospectively determined) independent of clinical relapse.
PLUS two of the following:
  • One or more T2-hyperintense lesions characteristic of MS in one or more of the following brain regions: periventricular, cortical or juxtacortical, or infratentorial.

  • Two or more T2-hyperintense lesions in the spinal cord.

  • Presence of CSF-specific oligoclonal bands.

  • Adapted from Thompson et al 12.

  • *MRI evidence of DIS—≥1 T2 hyperintense lesions characteristic of MS in ≥2 of four areas of the CNS: periventricular, cortical or juxtacortical, infratentorial brain, and spinal cord.

  • †MRI evidence of DIT—simultaneous presence of enhancing and non-enhancing lesions at any time or by a new T2-hyperintense or gadolinium enhancing lesion on a follow-up MRI with reference to a prior/baseline MRI.

  • ‡CSF-specific oligoclonal bands can substitute for the requirement of DIT.

  • CNS, central nervous system; CSF, spinal fluid; DIS, dissemination in space; DIT, dissemination in time; MS, multiple sclerosis.