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More than one clinical episode

Authoring team

More than one clinical episode (Relapsing-Remitting history)

  • 2017 criteria:
    • if a patient had >=2 distinct attacks and objective clinical evidence of >=2 lesions, no further testing was strictly needed to diagnose MS (though MRI was always done to confirm).
  • revised 2024 criteria:
    • remains unchanged
      • however, if they have the clinical episodes but only evidence of one lesion, the new 2024 rules make it much faster to prove "Dissemination in Space" by allowing the optic nerve to count as a location or by using advanced MRI markers like the Central Vein Sign (CVS) to confirm that the single lesion is definitively MS

Reference:

  1. Montalban X et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria. Lancet Neurol. 2025 Oct;24(10):850-865. doi: 10.1016/S1474-4422(25)00270-4. Erratum in: Lancet Neurol. 2025 Nov;24(11):e13.

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