Perspectives on Updated McDonald Criteria to Transform MS Diagnosis: Wallace Brownlee, MBChB, PhD, FRACP

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“I view this as a significant shift in how we diagnose MS, primarily because we no longer require a clinical syndrome, such as a relapse or progression. So, we’ll be diagnosing MS in patients with atypical symptoms or even no symptoms.”

The 2017 McDonald criteria initially created separate diagnostic standards for relapsing-remitting MS (RRMS) and primary progressive MS (PPMS), based on historical precedents rather than biological differences. Despite this, a recent study presented at the 2024 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, held September 18-20, in Copenhagen, Denmark, by lead author Wallace Brownlee, MBChB, PhD, FRACP, revealed that the 2017 criteria for RRMS demonstrated a high level of accuracy when applied to patients with PPMS.

The study also highlighted the feasibility of including the optic nerve as a fifth area of involvement and incorporating multiple spinal cord lesions into the dissemination in space criteria for PPMS. Overall, these findings suggested that future updates to the McDonald criteria could benefit from adopting a unified approach for diagnosing MS, aligning more closely with biological evidence while simplifying the diagnostic process in clinical practice.¹

Brownlee, a consultant neurologist at Queen's Square MS Center in London, United Kingdom, had an interview with NeurologyLive^® during the Congress to discuss how the newly updated criteria presented at the meeting will impact the clinical approach to diagnosing MS in patients with atypical or absent symptoms. He also talked about the implications of using unified diagnostic criteria for both relapsing-remitting and primary progressive MS. Moreover, Brownlee spoke about how global healthcare systems can ensure equitable access to MS diagnosis given the updated criteria and resource disparities.

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REFERENCES
1. Brownlee W, Vidal-Jordana A, Shatila M, et al. Towards a unified set of diagnostic criteria for multiple sclerosis. Presented at ECTRIMS Congress; September 18-20, 2024; Copenhagen, Denmark. Scientific Session 1: New diagnostic criteria. Abstract 1463.