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Diagnosing MS - The McDonald Criteria (Revised 2005) CHART
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 2005 Revised McDonald MS Diagnostic Criteria 1


 Source: National Multiple Sclerosis Society 2008





This is a quick reference chart.  For a detailed and thorough explanation please see Health Page: Diagnosing MS - The McDonald Criteria (revised 2005) "The Myth of the 9 Lesions"






Additional Requirements to make DX 
2 or more

2 or more

None. Clinical evidence alone will suffice; additional evidence desirable but must be consistent with MS

2 or more 1 Dissemination in space by MRI or 2 or more MRI lesions consistent w/MS plus positive CSF or await further clinical attack implicating other site
1 2 or more Dissemination in time by MRI or second clinical attack
1 1

Dissemination in space by MRI or 2 or more MRI lesions consistent with MS plus positive CSF 

AND dissemination in time by MRI or second clinical attack


 (progression from onset)

 1 or more

Disease progression for 1 year (retrospective or prospective) AND 2 out of 3 of the following:

  • Positive brain MRI (9 T2 lesions or 4 or more T2 lesions with positive VEP)
  • Positive spinal cord MRI (2 or more focal T2 lesions)
  • Positive CSF



1Polman et al. Diagnostic Criteria for Multiple Sclerosis: 2005 Revisions to the "McDonald" Criteria.  Annals of Neurology (2005) 58: 840-846



Paraclinical Evidence in MS Diagnosis





What is a Positive

MRI Showing Dissemination in Space?2,3


What Provides MRI Evidence of Dissemination in Time?

3 out of 4 of the following:

  • 1 Gd-enhancing brain or cord lesion or 9 T2 hyperintense brain and/or cord lesions if there is no Gd-enhancing lesion
  • 1 or more brain infratentorial or cord lesions
  • 1 or more juxtacortical lesions
  • 3 or more periventricular lesions

NOTE: Individual cord lesions can contribute along with individual brain lesions to reach required number of T2 lesions.

  • A Gd-enhancing lesion detected in scan at least 3 months after onset of initial clinical event at a site different from initial event

                -- or --

  • A new T2 lesion detected in a scan done at any time compared to a reference scan done at least 30 days after initial clinical event


What is Positive CSF?  2 or more Oligoclonal IgG bands in CSF (and not serum) or elevated IgG index
What is Positive VEP?  Delayed arrival of signal, but well-preserved wave form

2Barkhof et al. Brain (1997) 120: 2059-2069

3Tintore' et al. Am J Radiology (2000) 21: 702-706



These diagnostic criteria were developed through the consensus of the International Panel on the Diagnosis of MS.  See cited articles (above) for details.

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