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Key changes include recognition of the optic nerve as a fifth anatomical site for dissemination in space, incorporation of advanced MR imaging markers such as the central vein sign and paramagnetic rim lesions to improve specificity, and acceptance of the kappa free light chain index as a quantitative alternative to oligoclonal bands. In selected patients with highly characteristic clinical and imaging features, MS may now be diagnosed without demonstration of dissemination in time, reducing diagnostic delay. A unified pathway across relapsing and progressive phenotypes, including children, promotes consistency, while defined pathways also allow diagnosis in certain asymptomatic individuals, including those with radiologically isolated syndrome, when supported by biomarkers. Implementation will require access to advanced imaging, standardised laboratory testing, multidisciplinary expertise and careful clinical judgement to minimise misdiagnosis and ensure equitable access.<\/jats:p>","DOI":"10.1136\/pn-2025-004938","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T19:00:36Z","timestamp":1779822036000},"page":"440-448","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["The 2024 McDonald criteria for the diagnosis of multiple sclerosis: implications for clinical practice"],"prefix":"10.1136","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5024-3615","authenticated-orcid":false,"given":"Tarunya","family":"Arun","sequence":"first","affiliation":[{"name":"University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"},{"name":"University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Petheram","sequence":"additional","affiliation":[{"name":"Neurology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasanee","family":"Braithwaite","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, King\u2019s Health Partners, London, UK"},{"name":"The Medical Eye Unit, Department of Ophthalmology, Guy's and St Thomas\u2019 Hospital NHS Foundation Trust, London, UK"},{"name":"School of Lifecourse and Population Science, Kings College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wallace J","family":"Brownlee","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK"},{"name":"(2) National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen L","family":"Ford","sequence":"additional","affiliation":[{"name":"Neurology, Leeds Centre for Neurosciences, Leeds, UK"},{"name":"University of Leeds Faculty of Medicine and Health, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Neurology, Institute of Neurological Sciences, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Hughes","sequence":"additional","affiliation":[{"name":"Belfast Health and Social Care Trust, Belfast, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Palace","sequence":"additional","affiliation":[{"name":"Clinical Neurology, Oxford University Hospitals Trust, Oxford, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-4426","authenticated-orcid":false,"given":"Claire M","family":"Rice","sequence":"additional","affiliation":[{"name":"Institute of Clinical Neurosciences, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Anand","family":"Trip","sequence":"additional","affiliation":[{"name":"Queen Square MS Centre, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikos","family":"Evangelou","sequence":"additional","affiliation":[{"name":"Division of Clinical Neurology, Queens Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"2026092100401126000_26.5.440.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(25)00270-4"},{"key":"2026092100401126000_26.5.440.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"2026092100401126000_26.5.440.3","unstructured":"J-M C . 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