McDonald Criteria for Multiple Sclerosis Diagnosis (2017 Revision)

McDonald 2017 criteria assessed -- see action for diagnosis and management

→ DEFINITE MS if: DIS and DIT criteria both met clinically or via MRI (as per formula above); with CSF positive for oligoclonal bands (OCB), DIT can be inferred in CIS with a single attack and positive MRI if DIS is met. POSSIBLE MS (CIS): single clinical attack, DIS criteria met, DIT criteria NOT yet met -- monitor with repeat MRI at 6-12 months; high conversion risk if multiple MRI lesions. NOT MS if no better explanation and criteria not met -- consider: NMOSD (AQP4-IgG/MOG-IgG antibodies), ADEM, CNS vasculitis, Lyme disease, B12 deficiency, sarcoidosis. Management once MS diagnosed: refer to MS specialist immediately; discuss disease-modifying therapy (DMT) -- first-line: beta-interferon, glatiramer acetate, dimethyl fumarate (tecfidera), teriflunomide; high-efficacy: natalizumab, alemtuzumab, cladribine, ocrelizumab (NICE TA303/533/585/584); relapse management: methylprednisolone 500 mg-1 g IV for 3-5 days; MS specialist nurse; patient support (MS Society, Shift.ms); fertility/pregnancy counselling for DMT choice; vitamin D supplementation (evidence for reduced relapse).