{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:45:45Z","timestamp":1792226745605,"version":"4.4.0"},"reference-count":102,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007155","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/S026088\/1"],"award-info":[{"award-number":["MR\/S026088\/1"]}],"id":[{"id":"10.13039\/501100007155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EME Programme"},{"DOI":"10.13039\/501100000381","name":"UK MS Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000381","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100029249","name":"Horne Family Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100029249","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diagnostic criteria for multiple sclerosis have evolved substantially since the Schumacher criteria were published in 1965. The most recent iteration, the 2024 McDonald diagnostic criteria, was recently released. Each revision has broadened the range of evidence that can support diagnosis while attempting to preserve specificity. The central question raised by the 2024 revision is therefore not simply whether the criteria are valid in principle, but whether they can be applied safely outside expert centres, where imaging quality, laboratory infrastructure and subspecialist interpretation vary substantially.<\/jats:p>\n                  <jats:p>In this review, we evaluate the 2024 criteria not only as a consensus document but as an intervention in clinical behaviour, with particular attention to misdiagnosis risk, operational feasibility and equity of implementation. In particular, we consider the role of the optic nerve and of the central vein sign and paramagnetic rim lesions in diagnosis, and how the criteria bring more diverse populations and presentations into consideration. We also review how the greater options available to achieve a diagnosis may introduce heterogeneity into diagnostic approaches, and what safeguards can be taken to minimize the risk of inappropriate application of the criteria and subsequent misdiagnosis (and inappropriate treatment). The review finishes by proposing how the changes introduced in this iteration might be refined, with more robust definitions on acquiring and interpreting the novel biomarkers.<\/jats:p>","DOI":"10.1093\/brain\/awag293","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:45:56Z","timestamp":1787921156000},"source":"Crossref","is-referenced-by-count":1,"title":["Diagnosing multiple sclerosis: implementation and unintended effects of the 2024 McDonald criteria"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7201-7475","authenticated-orcid":false,"given":"Michael A","family":"Foster","sequence":"first","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London , London WC1B 5EH ,","place":["UK"]},{"name":"Department of Neurology, Queen\u2019s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust , Romford RM7 0AG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Wade","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London , London WC1B 5EH ,","place":["UK"]},{"name":"Department of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust , London WC1N 3BG ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen L","family":"Ford","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Health and Life Sciences, University of Leeds , Leeds LS2 9JT ,","place":["UK"]},{"name":"Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust , Leeds LS1 3EX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9293-8893","authenticated-orcid":false,"given":"Klaus","family":"Schmierer","sequence":"additional","affiliation":[{"name":"Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust , London E1 1FR ,","place":["UK"]},{"name":"Centre for Neuroscience, Surgery & Trauma, The Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London , London E1 2AT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"2026101614021263000_awag293-B1","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/S1474-4422(25)00270-4","article-title":"Diagnosis of multiple sclerosis: 2024 revisions of the McDonald criteria","volume":"24","author":"Montalban","year":"2025","journal-title":"Lancet Neurol"},{"key":"2026101614021263000_awag293-B2","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1136\/pn-2025-004938","article-title":"The 2024 McDonald criteria for the diagnosis of multiple sclerosis: Implications for clinical practice","volume":"26","author":"Arun","year":"2026","journal-title":"Pract Neurol"},{"key":"2026101614021263000_awag293-B3","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1111\/j.1749-6632.1965.tb20235.x","article-title":"Problems of experimental trials of therapy in multiple sclerosis: Report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis","volume":"122","author":"Schumacher","year":"1965","journal-title":"Ann N Y Acad Sci"},{"key":"2026101614021263000_awag293-B4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/ana.410130302","article-title":"New diagnostic criteria for multiple sclerosis: Guidelines for research protocols","volume":"13","author":"Poser","year":"1983","journal-title":"Ann Neurol"},{"key":"2026101614021263000_awag293-B5","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1002\/ana.1032","article-title":"Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the diagnosis of multiple sclerosis","volume":"50","author":"McDonald","year":"2001","journal-title":"Ann Neurol"},{"key":"2026101614021263000_awag293-B6","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1002\/ana.20703","article-title":"Diagnostic criteria for multiple sclerosis: 2005 revisions to the \u201cMcDonald Criteria\u201d","volume":"58","author":"Polman","year":"2005","journal-title":"Ann Neurol"},{"key":"2026101614021263000_awag293-B7","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1002\/ana.22366","article-title":"Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald 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Arabia","volume":"104","author":"Malik","year":"2025","journal-title":"Mult Scler Relat Disord"},{"key":"2026101614021263000_awag293-B14","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1177\/1352458520988148","article-title":"The frequency and characteristics of MS misdiagnosis in patients referred to the multiple sclerosis centre of Catalonia","volume":"27","author":"Midaglia","year":"2021","journal-title":"Mult Scler"},{"key":"2026101614021263000_awag293-B15","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1177\/13524585211067521","article-title":"The frequency and characteristics of multiple sclerosis misdiagnosis in Latin America: A referral center study in Buenos Aires, Argentina","volume":"28","author":"Gait\u00e1n","year":"2022","journal-title":"Mult Scler"},{"key":"2026101614021263000_awag293-B16","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1016\/S0140-6736(05)63920-7","article-title":"Misdiagnosis of multiple sclerosis and 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