RAPID COMMUNICATION Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria 1 Chris H. Polman, MD, PhD, Stephen C. Reingold, PhD, Brenda Banwell, MD, 2 3 Michel Clanet, MD,4 Jeffrey A. Cohen, MD,5 6 Massimo Filippi, MD, Kazuo Fujihara, MD, 7 Eva Havrdova, MD, PhD, 8 Michael Hutchinson, MD,9 Ludwig Kappos, MD,10 Fred D. Lublin, MD,11 Xavier Montalban, MD,12 Paul O’Connor, MD,13 Magnhild Sandberg-Wollheim, MD, PhD,14 Alan J. Thompson, MD,15 Emmanuelle Waubant, MD, PhD,16 Brian Weinshenker, MD,17 and Jerry S. Wolinsky, MD18 New evidence and consensus has led to further revision of the McDonald Criteria for diagnosis of multiple sclerosis. The use of imaging for demonstration of dissemination of central nervous system lesions in space and time has been simplified, and in some circumstances dissemination in space and time can be established by a single scan. These revisions simplify the Criteria, preserve their diagnostic sensitivity and specificity, address their applicability across populations, and may allow earlier diagnosis and more uniform and widespread use. Dclinical iagnostic and criteria paraclinical for multiple laboratory sclerosis assessments1,2 (MS) include emphasizing the need to demonstrate dissemination of lesions in space (DIS) and time (DIT) and to exclude alter- native diagnoses. Although the diagnosis can be made on clinical grounds alone, magnetic resonance imaging (MRI) of the central nervous system (CNS) can support, supple- ment, or even replace some clinical criteria,3–9 as most recently emphasized by the so-called McDonald Criteria of the International Panel on Diagnosis of MS.8,9 The McDo- nald Criteria have resulted in earlier diagnosis of MS with a high degree of both specificity and sensitivity,10–13 allowing for better counseling of patients and earlier treatment. Since the revision of the McDonald Criteria in 2005, new data and consensus have pointed to the need ANN NEUROL 2011;69:292–302 for their simplification to improve their comprehension and utility and for evaluating their appropriateness in pop- ulations that differ from the largely Western Caucasian adult populations from which the Criteria were derived. In May 2010 in Dublin, Ireland, the International Panel on Diagnosis of MS (the Panel) met for a third time to examine requirements for demonstrating DIS and DIT and to focus on application of the McDonald Criteria in pediatric, Asian, and Latin American populations. Considerations Related to Revisions to the McDonald Criteria The Panel reviewed published research related to the di- agnosis of MS and to the original and revised McDonald Criteria, gathered from literature searches of English View this article online at wileyonlinelibrary.com. DOI: 10.1002/ana.22366 Received Nov 2, 2010, and in revised form Dec 23, 2010. Accepted for publication Dec 29, 2010. Address correspondence to Dr Polman, Department of Neurology, VU Medical Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands. E-mail: ch.polman@vumc.nl From the 1Department of Neurology, Free University, Amsterdam, the Netherlands; 2Scientific and Clinical Review Associates LLC, New York, NY; 3Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; 4Department of Neurosciences, University Hospital Center, Toulouse, France; 5Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinical Foundation, Cleveland, OH; 6Neuroimaging Research Unit, Division of Neuroscience, Scientific Institute and University Hospital San Raffaele, Milan, Italy; 7Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan; 8Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic; 9St Vincent’s University Hospital, Elm Park, Dublin, Ireland; 10Departments of Neurology and Biomedicine, University Hospital, Kantonsspital, Basel, Switzerland; 11Corrine Goldsmith Dickinson Center for Multiple Sclerosis, Department of Neurology, Mount Sinai School of Medicine, New York, NY; 12Clinical Neuroimmunology Unit, Multiple Sclerosis Center of Catalonia, University Hospital Vall d’Hebron, Barcelona, Spain; 13Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; 14Department of Neurology, University Hospital, Lund, Sweden; 15University College London Institute of Neurology, United Kingdom; 16Multiple Sclerosis Center, University of California, San Francisco, CA; 17Department of Neurology, Mayo Clinic, Rochester, MN; and 18Department of Neurology, University of Texas Health Sciences Center, Houston, TX. 292 VC 2011 American Neurological Association