Neurology Exam Prep Podcast Episode 75 - Diagnostic Criteria for Multiple Sclerosis
Sep 11, 2025
Dinesh Sivakolundu is wrapping up his neuroimmunology training at Cornell, while Kevin Yan is finishing his neuro-ophthalmology training at Emory. They dive into the evolution of multiple sclerosis diagnostic criteria, highlighting the critical updates in the 2024 McDonald criteria. The discussion emphasizes the importance of early detection, especially with optic neuritis, and the complexities of diagnosing progressive MS. Their insights shed light on how advancements in biomarkers and clear diagnostic criteria can enhance treatment timelines.
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Core McDonald Requirements
- MS diagnosis requires both dissemination in space and dissemination in time plus at least one clinical attack for RRMS under 2017 McDonald criteria.
- This framework risks delaying diagnosis because radiographic lesions often outnumber clinical attacks.
RIS Frequently Progresses
- Radiologically isolated syndrome (RIS) patients often convert to clinical MS over years, with about 75% converting within 10 years.
- This mismatch motivated proposed 2024 changes to diagnose earlier using imaging and biomarkers.
Optic Nerve Added As Region
- The 2024 proposal adds the optic nerve as a fifth topographical region for dissemination in space.
- Optic nerve inclusion recognizes optic neuritis as a common MS presenting feature and expands diagnostic options.
