A new era for MS diagnosis

The international standards for diagnosing multiple sclerosis (MS), known as the McDonald criteria have been updated, marking a major milestone in improving early and accurate diagnosis. The revised guidelines and advanced technologies bring hope for earlier and more accurate care.  

Named after Professor Ian McDonald, who first developed the criteria in 2001, the guidelines have been revised alongside advances in research and technology. The latest update was agreed by the International Advisory Committee on Clinical Trials in MS, which includes 56 experts from 16 countries, including Australian researchers, in clinical care, radiology, epidemiology, methodology and patient perspectives.  

Published in The Lancet Neurology, the 2024 update builds on the existing 2017 criteria by introducing new tools and markers. These changes create a more unified approach for diagnosing MS in people with relapsing or progressive courses across all ages. This means that people showing early signs of MS may now receive a confirmed diagnosis sooner and with greater accuracy.  

According to MS Australia’s World MS Day My Diagnosis Report, MS diagnosis in Australia currently takes an average of nearly four years from the onset of symptoms.   

The revised McDonald criteria aim to shorten this timeframe through several key changes:  

• Earlier diagnosis, sometimes after a single clinical episode.  
• Recognition of radiologically isolated syndrome using MRI scans and laboratory markers to reveal characteristic brain, spinal cord or optic nerve inflammation before clinical symptoms appear. 
• New, less invasive diagnostic tools such as eye scans (optical coherence tomography) and newer spinal fluid tests (kappa free light chains). 
• Expanded criteria to improve diagnostic accuracy in children and adults over 50.  

Recent studies have already shown encouraging results. 

• In Spain, Dr Luca Bollo applied the updated criteria to 300 patients being checked for MS and found diagnoses increased from 47% under the previous 2017 criteria to 71% under the new 2024 criteria.  
• In the UK, Dr Wallace Brownlee tested on nearly 200 people in a real clinic and reported that more diagnoses under the new criteria and far fewer were left in the ‘maybe’ category.  

These outcomes mean that fewer people will be left waiting and wondering and more people with MS will get timely access to treatment and support.  

The update also reflects a wider shift in MS research toward more precise and personalised care.  

At the 2025 European Committee for Treatment and Research in MS (ECTRIMS), researchers showcased exciting advances in artificial intelligence (AI) and brain imaging that could help clinicians understand each person’s type of MS.  

Using machine learning, Dr Alessia Bianchi analysed MRI scans and identified hidden MS subtypes: 

1. Some with early lesion activity.
2. Others with more widespread brain shrinkage.  

Understanding these patterns could help clinicians predict disease progression and guide treatment choices.  

In another study, Dr Paola Valsasina used AI to analyse MRI scans and clinical data from over 2000 people. The technology could distinguish MS from non-MS cases with up to 95% accuracy and even predict future disability based on brain lesion volume and size. These tools could soon improve monitoring and help clinicians provide more individualised care.  

Another development at ECTRIMS presented by Dr Ahmed Abdelhak found changes in certain blood proteins up to eight years before. This discovery raises that a simple blood test could one day identify people at risk of MS, allowing earlier intervention and preventing nerve damage.  

Together, these updates represent a new era in MS care. The combination of clearer diagnostic criteria, smarter imaging and innovative biomarker research will enable people with MS to start treatment sooner and with greater confidence.  

However, ensuring equitable access to advanced MRI and laboratory testing remains essential, especially in regions where diagnostic resources are limited.  

As international collaboration continues, the future of MS care looks increasingly hopeful with faster diagnosis, personalised care and improved long-term outcomes for people with MS worldwide.