2024 revised McDonald Criteria for Multiple Sclerosis

The 2024 revisions to the McDonald criteria for Multiple Sclerosis were recently presented at the 2024 ECTRIMS conference in Copenhagen by professor Xavier Montalban and include several important changes. THe goal of the changes is to refine the balance between sensitivity and specificity of the MS diagnosis. The goal is to be able to diagnose MS as early as possible, but also ruling out other conditions. In the end, MS is still a diagnosis of exclusion that can only be made when other conditions are ruled out. Detection of white matter lesions in the brain and/or spinal cord is essential for the dagnosis, as an abnormal MRI is required for the diagnosis.

New in the 2024 criteria are:
- The introduction of the optic nerve as a fifth topographical location.
- The number of topographic locations for dissemination of space.
- The criterium "dissemination in time" is not always needed.
- The central vein sign can now be used as a diagnostic criterium.
- Paramagnetic rim lesions can now be used as diagnostic lesions.
- MS diagnosis can be made in previous radiologically isolated syndrome.

0:00 - Introduction
3:01 - Case: DIS & DIT
5:41 - Dissemination in space (DIS)
6:38 - Dissemination in time (DIT)
8:27 - Summary: DIS, DIT & 2024 revisions
10:37 - Case: Optic neuritis as a fifth CNS-topography
14:47 - Case: 4 CNS-topographies = MS
16:24 - The Central Vein Sign
19:20 - Paramagnetic Rim Lesions
23:07 - CVS & PMRs for the diagnosis of MS?
24:31 - Case: one topography + CVS/PMR + DIT/CSF
26:24 - Primary Progressive Multple Sclerosis
27:28 - Radiologically isolated syndrome (RIS)
31:04 - Age & comorbidities, when is it MS?
32:35 - Summary

This video is brought to you by the neuroradiologist:

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[MS-qfbt]

Thank you very much for enriching youtube with your knowledge and way of teaching stuff. Hello from Germany!!

[raelenesharp-rczw]

Very informative…I’ve had MS since age 28 and now aged 64. Still active and mobile, but constant fatigue, weakness and cognitive slowing when hot or fatigued is overwhelming in Perth, Western Australian heat. Thankyou for your video…🇦🇺🦘

[mariosgavriil]

I am starting my neurology residency in a couple of weeks, your videos have been a great tool for me to understand difficult topics. Keep up the good work and remember that through your presentations not only do you help us doctors but also our future patients!

[AbaCissé-xf]

Very nice presentation. You make it easy understanding for us. Congratulations 🎉❤
really enjoyed It 😊👌

[Anonimo-usez]

Thanks for the presentation. Although In the ECTRIMS was published, the inclusion of the optic nerve as the fifth location is already considered a criterion, or do we need to wait for it to be published in another official way?” Thanks!

[sensationfreak]

Thanks for the really clear and well summarized explanation!!

[josephvered]

Hi from Israel amazing video thanks dear doctor

[woepz]

34:10 “Don’t forget to add: *CVS* .” Lesions in ≥ 2 CNS
topographies : DIT! CSF +, ≥ 4 topographies, *6 CVS*

[nwmw]

Great presentation. Thank you very much...!

[SarahDjabri-jq]

Thanks for the excellent presentation. I woul lik to ask if we should treate radiological isoletate syndrome according to ECTRIMS 2024 ? If the patient has no symptoms and fulfil criteria ?

[nobody]

Thank you so much!! Great video, I inhaled the content.

[bezczekolady]

Dear Sven, great presentation .
What kind of „other patologies” are you excluding first before diagnosis of MS? Do You have specific checklist of depens on the clinical context.thanx

[小池メリアン]

I diagnose MS.😢What can u advice or what treatment to do?😵😢😢😢