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Additional Data Needed for MS Diagnosis
Two or more attacks; objective clinical evidence of 2 or more lesions None(a)
Two or more attacks; objective clinical evidence of 1 lesion

Dissemination in space demonstrated by:

* MRI(b), or
* 2 or more MRI lesions consistent with MS plus positive CSF(c), or
* await further clinical attack implicating a different site.

One attack; objective clinical evidence of 2 or more lesions

Dissemination in time demonstrated by:

* MRI(b), or
* second clinical attack.

One attack; objective clinical evidence of 1 lesion (clincally isolated syndrome)

Dissemination in space demonstrated by:

* MRI(b), or
* 2 or more MRI lesions consistent with MS plus positive CSF(c)

And dissemination in time, demonstrated by:

* MRI(b), or
* Second clinical attack

Insidious neurological progression suggestive of MS

Positive CSF(c), and dissemination in space,
demonstrated by:

* 1) 9 or more T2 lesions in brain, or 2) 2 or more lesions in spinal cord, or 3) 4-8 brain lesions plus 1 spinal cord lesion; or
* Abnormal visual evoked potentials with MRI demonstrating 4-8 brain lesions, or fewer than 4 brain lesions plus 1 spinal cord lesion; and

* Dissemination in time demonstrated by MRI(b); or
* Continued progression for 1 year

(a) Brain MRI is recommended to exclude other etiologies
(b) MRI criteria for dissemination in space or time are described in Table 2
(c) Positive CSF defined as oligoclonal bands different from those in serum, or raised IgG index.
Adapted from reference 6.
Copyright 2002 The Cleveland Clinic Foundation

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