Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria

Montalban, X.; Lebrun-Frenay, C.; Oh, J.; Arrambide, G.; Moccia, M.; Pia Amato, M.; Amezcua, L.; Banwell, B.; Bar-Or, A.; Barkhof, F.; Butzkueven, H.; Ciccarelli, O.; Chataway, J.; Cohen, J. A.; Comi, G.; Correale, J.; Deisenhammer, F.; Filippi, M.; Fiol, J.; Freedman, M. S.; Fujihara, K.; Granziera, C.; Green, A. J.; Hartung, H. -P.; Hellwig, K.; Kappos, L.; Kimbrough, D.; Killestein, J.; Lublin, F.; Marignier, R.; Ann Marrie, R.; Miller, A.; Otero-Romero, S.; Ontaneda, D.; Ramanathan, S.; Reich, D.; Rocca, M. A.; Rovira, A.; Saidha, S.; Salter, A.; Sastre-Garriga, J.; Saylor, D.; Solomon, A. J.; Sormani, M. P.; Stankoff, B.; Tintore, M.; Tremlett, H.; Van Der Walt, A.; Viswanathan, S.; Wiendl, H.; Wildemann, B.; Yamout, B.; Zaratin, P.; Calabresi, P. A.; Coetzee, T.; Thompson, A. J.

doi:10.1016/S1474-4422(25)00270-4

Advances in the understanding of multiple sclerosis and the development of biomarkers of pathophysiology prompted a substantial revision of the 2017 McDonald diagnostic criteria. The new 2024 McDonald criteria provide a unified approach for diagnosing multiple sclerosis in individuals with relapsing or progressive courses throughout the lifespan (ie, from paediatric to late-life presentations). The optic nerve can now serve as a fifth anatomical location within the CNS for diagnosis. The central vein sign, paramagnetic rim lesions, and kappa free-light chain concentrations in CSF can be used, when available, to provide supportive evidence and confer specificity for a diagnosis of multiple sclerosis in specific situations. In certain cases, radiologically isolated syndrome or neurological symptoms that do not constitute a clear attack or progression of disability can fulfil the criteria for a multiple sclerosis diagnosis. We also provide guidance for the diagnosis of multiple sclerosis in older individuals (≥50 years) and those with comorbidities. The 2024 revised criteria should expedite the diagnosis of multiple sclerosis, while maintaining specificity.

Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria / Montalban, X.; Lebrun-Frenay, C.; Oh, J.; Arrambide, G.; Moccia, M.; Pia Amato, M.; Amezcua, L.; Banwell, B.; Bar-Or, A.; Barkhof, F.; Butzkueven, H.; Ciccarelli, O.; Chataway, J.; Cohen, J. A.; Comi, G.; Correale, J.; Deisenhammer, F.; Filippi, M.; Fiol, J.; Freedman, M. S.; Fujihara, K.; Granziera, C.; Green, A. J.; Hartung, H. -P.; Hellwig, K.; Kappos, L.; Kimbrough, D.; Killestein, J.; Lublin, F.; Marignier, R.; Ann Marrie, R.; Miller, A.; Otero-Romero, S.; Ontaneda, D.; Ramanathan, S.; Reich, D.; Rocca, M. A.; Rovira, A.; Saidha, S.; Salter, A.; Sastre-Garriga, J.; Saylor, D.; Solomon, A. J.; Sormani, M. P.; Stankoff, B.; Tintore, M.; Tremlett, H.; Van Der Walt, A.; Viswanathan, S.; Wiendl, H.; Wildemann, B.; Yamout, B.; Zaratin, P.; Calabresi, P. A.; Coetzee, T.; Thompson, A. J.. - In: LANCET NEUROLOGY. - ISSN 1474-4422. - 24:10(2025), pp. 850-865. [10.1016/S1474-4422(25)00270-4]