Evolution of Multiple Sclerosis Diagnostic Criteria and the Role of Spinal Taps: David A. Hafler, MD, FANA

WATCH TIME: 5 minutes

“Ultimately, I should point out that the diagnosis of [multiple sclerosis] is a pathological diagnosis, and what we do clinically is add various measurements that increase the probability of making an accurate diagnosis.”

The McDonald Diagnostic Criteria, first introduced in 2001 and updated most recently in 2017, offers neurologists a framework designed to enhance the accuracy and speed of multiple sclerosis (MS) diagnoses. Since the last update, an expert committee has worked on further updates to incorporate recent advancements in the understanding of MS, with the goal of enabling earlier identification of the disease to improve patient outcomes. The newer updated revision emphasizes a deeper understanding of the biological mechanisms of MS, facilitating more precise assessments alongside clinical symptom evaluation.¹

At the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 18-20 in Copenhagen, Denmark, key recommendations from the new revision were presented. These include the adoption of advanced diagnostic methods and the development of age-specific criteria to more accurately diagnose MS in both younger and older populations. The aim of these changes is to enhance diagnostic precision by examining biomarkers of MS-related damage that go beyond observable symptoms. The committee is preparing a peer-reviewed publication of the finalized updates, expected by early 2025.²

Recently, David A. Hafler, MD, FANA, the William S. and Lois Stiles Edgerly Professor of Neurology at Yale School of Medicine, sat down with NeurologyLive^® to discuss how advancements in technologies have improved the diagnostic criteria for MS, and how this has impacted the clinical practice. Hafler, who also serves as the Neurologist-in-Chief at the Yale-New Haven Hospital, talked about why the term "definitive" MS should be discarded, and how this would reflect the evolving approach to MS diagnosis. Moreover, he spoke about how age affects the accuracy of an MS diagnosis, and how the approach differs when diagnosing younger versus older patients.

REFERENCES
1. Montalban X. 2024 Revisions of the McDonald Criteria. Presented at ECTRIMS Congress; September 18-20, 2024; Copenhagen, Denmark. Scientific Session 1: New diagnostic criteria.
2. European Committee for Treatment and Research in MS. McDonald Diagnostic Criteria. Accessed November 12, 2024. https://ectrims.eu/mcdonald-diagnostic-criteria#