Dr Andrew Solomon Discusses the Correct Application of the McDonald Criteria in Diagnosing MS

Multiple sclerosis (MS) can be a challenging disease to diagnose because of its broad range of symptoms and because of the fact that many other syndromes can mimic MS. Additionally, the McDonald Criteria, which are clinical, radiographic, and laboratory criteria used for diagnosing MS, are sometimes misapplied, according to Andrew Solomon, MD, associate professor of neurological sciences and division chief of multiple sclerosis at Larner College of Medicine, The University of Vermont, Burlington, Vermont.

Transcript

What are some tips that you gave in your presentation on avoiding misdiagnosis in multiple sclerosis?

In this presentation, because it seems that difficulty with the McDonald Criteria could lead to misdiagnosis, we really emphasized a lot of tips and advice on how to properly use the criteria. There’s a lot of, perhaps, misconceptions about the diagnostic criteria.

Really the most important thing is to first read the document. Read the manuscript, because a lot of times, the diagnostic criteria for MS are reproduced on little cards that don’t have all the caveats for different diagnostic situations. So it’s important to know all the details first.

We emphasized in this session that the first step of making a diagnosis of MS is identifying if a syndrome in a patient that you’re seeing is what we call typical for MS, or an MS-typical syndrome, and that there’s evidence, objective evidence, we call it, of [central nervous system, CNS] involvement. So, corroborating evidence on their neurologic exam or MRI that there’s a lesion responsible for the syndrome. That’s the first step in making a diagnosis of MS.

If the syndrome is atypical, or there’s some red flag, something that’s unusual, you can’t really even apply the McDonald criteria, because it hasn’t been validated in patients like that and would lose its specificity.

So being very familiar with what those syndromes are, which are essentially optic neuritis, myelitis, and some brain stem syndromes, that’s it, and knowing how to verify that there’s objective evidence of those syndromes is a really key skill in making a correct diagnosis.