Diagnostic criteria for multiple sclerosis
Clinical presentation | Additional data needed for MS diagnosis |
Relapse/attack at onset | |
≥2 clinical attacks and ≥2 lesions with objective clinical evidence | None |
≥2 clinical attacks and one lesion plus historical evidence of attack in different location | None |
≥2 clinical attacks and evidence of 1 lesion with objective clinical evidence | Dissemination 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 evidence | Dissemination 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 evidence | Dissemination 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:
|
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.