Stages and courses of multiple sclerosis (MS):
- Clinically isolated syndrome (CLS) – initial stage of clinical presentation.
- There is an initial symptom suggestive of multiple sclerosis. The diagnosis is not yet confirmed; however, a second episode occurs in 30% of patients with HIS within one year.
- Relapsing-remitting (“RRMS”) form of progression.
- Sudden onset of disease symptoms that temporarily subside.
- Occurs in 85% of cases in the early stages.
- Primary (chronic) progressive form of progression (PPMS).
- Continuous course, no relapses.
- The disease already begins with insidious symptoms.
- No significant regression of symptoms.
- Occurs in 15% of cases.
- Secondary (chronic) progressive course (SPMS).
- In this form, the disease begins relapsing, but later changes to a progressive course.
- Gradual increase in clinical symptoms and neurological impairment.
- The regression of symptoms after a relapse is increasingly incomplete.
In over 80% of cases, multiple sclerosis begins with a relapsing course. Often, the disease progresses over time to a secondary progressive course. Explanation of McDonald criteria 2010
Clinical presentation | Additional parameters that must be present for a diagnosis of MS | |
1 | ≥ 2 relapses; ≥ 2 objectively demonstrable lesions + evidence of a precedingrelapse event. | None |
2 | ≥ 2 relapses; one objectively demonstrable lesion. | Spatial dissemination, evidence by:
|
3 | 1 thrust; ≥ 2 objectively demonstrated lesions. | Temporal dissemination, evidence by:
|
4 | 1 episode; one objectively demonstrated lesion (clinically isolated syndrome [CIS]) |
Spatial dissemination:
temporal dissemination:
|
5 | Gradual neurological progression (PPMS). |
|
Innovations in the McDonald criteria
- If patients with clinically isolated syndrome (CIS) meet the criterion for spatial dissemination (scattering) and there is no other explanation for their symptoms, a diagnosis of MS is now also possible by detection of oligoclonal bands. That is, spatial dissemination in combination with a positive CSF analysis is sufficient as a diagnostic criterion for HIS.
- Both symptomatic and asymptomatic lesions may now be used for spatial and temporal dissemination.
- In addition to juxtacortical lesions, cortical lesions may now indicate spatial dissemination.
- For the diagnosis of primary progressive MS, cortical and symptomatic lesions are now also allowed for the detection of dissemination.
- With the diagnosis, physicians should use the history to determine the preliminary course of the disease based on the diagnosis, i.e., to indicate whether the disease is relapsing-remitting (“relapsing-remitting”, RRMS), primary (chronic) progressive (PPMS), or secondary (chronic) progressive (SPMS). Furthermore, it should be indicated whether there is an active disease with rapid disability progression (see below “Stages and courses of multiple sclerosis (MS)”).