The 2024 McDonald criteria strongly recommend the confirmation of objective evidence of central nervous system involvement by imaging in addition to clinical findings, while additional biomarkers may be needed in specific instances. However, if these paraclinical tools are unavailable, a pragmatic approach incorporating clinical findings is permitted. MS diagnosis requires careful neurologic evaluation and expertise for the interpretation of paraclinical findings; the accurate performance of the diagnostic criteria still relies on the clinician's knowledge of typical clinical presentations and MRI findings of MS and the recognition of red flags suggesting alternative diagnoses. The revised criteria can be applied at all ages and for asymptomatic individuals; however, caution is required to avoid misdiagnosis, particularly for pediatric, older-onset, and asymptomatic presentations.
Arrambide et al. (Wed,) studied this question.