Applying the 2024 McDonald Criteria: Real-World Impacts on MS Diagnosis

Announcer:  
You’re listening to NeuroFrontiers on ReachMD. On this episode, we’ll hear from Dr. Aaron Miller, the Medical Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis and a Professor of Neurology at the Icahn School of Medicine at Mount Sinai in New York. He’ll be discussing real-world applications of the updated McDonald Diagnostic Criteria for multiple sclerosis, which he spoke about at the 2026 American Academy of Neurology Annual Meeting. Here’s Dr. Miller now. 

Dr. Miller: 
There are a lot of people we can pick up who we wouldn't have diagnosed in 2017. So, where are we in real-world experience so far? Well, there’s only been a couple of publications so far, but they are already very encouraging. So far, it looks like there's a very substantial increase in the number of people who can be diagnosed with MS using the 2024 criteria compared to 2017, and most of those are accounted for either by the presence of the optic nerve involvement, which didn't count before, or they're people who we would've previously classified as radiologically isolated syndrome, and it now can be called MS.

In terms of practitioners in the community wanting to use these criteria, although we don't have a specific algorithm for how you should proceed because different centers or practices will have different tools available—for example, the advanced imaging techniques are not generally available at the present time—we anticipate that within the next couple of years, most of the major MRI manufacturers will have protocols approved that include the right sequences for good detection of central veins or PRLs. But most centers might not have that at the moment. Some centers might not have access to visual evoked potentials, for example, and there are some parts of the world where you might not even be able to get an MRI. But it would be very rare to diagnose MS when you do not have MRIs. 

So, because of this variability, we don't have a specific algorithm, but I would refer our listeners to the National MS Society, which has materials on the new McDonald criteria on the website, including some very good flow diagrams that show you the criteria that are needed in each of these circumstances. In addition, the National MS Society, around the time of the academy meeting, will be launching an e-learning module, which is an exercise that practitioners can utilize to help them become familiar and comfortable with the 2024 McDonald criteria.

Announcer:
That was Dr. Aaron Miller sharing insights on how we can implement the 2024 McDonald Diagnostic Criteria in multiple sclerosis care. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!