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A paradigm shift away from dissemination in time in multiple sclerosis

Nature Reviews Neurology (2025)Cite this article

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In the 2024 revisions of the McDonald criteria for diagnosis of multiple sclerosis (MS), dissemination in time is no longer required. This paradigm shift is the result of advances in understanding of MS and the development of other biomarkers, enabling earlier diagnosis and treatment that will ultimately improve long-term outcomes.

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Authors and Affiliations

  1. Department of Neurology-Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Agustín Pappolla, Georgina Arrambide & Xavier Montalban

  2. Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Agustín Pappolla, Georgina Arrambide & Xavier Montalban

  3. Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic/Manresa, Spain

    Xavier Montalban

Authors
  1. Agustín Pappolla
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  2. Georgina Arrambide
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  3. Xavier Montalban
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Corresponding author

Correspondence to Agustín Pappolla.

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Competing interests

A.P has received travel funding from Roche and speaking honoraria from Novartis. G.A has received compensation for consulting services, speaking honoraria or participation in advisory boards from Bristol Myers Squibb, Horizon Therapeutics and Roche; has received travel support for scientific meetings from The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), the European Academy of Neurology, Novartis and Roche; is a member of the International Women in Multiple Sclerosis network executive committee, the European Biomarkers in Multiple Sclerosis steering committee, the MOGAD Eugene Devic European Network steering group and the Platform Adaptive Trial for Remyelination and Neuroprotection in Multiple Sclerosis steering committee; and has participated in the steering team for the 2024 McDonald Diagnostic Criteria Preparatory Working Group by the International Advisory Committee on Clinical Trials in Multiple Sclerosis. X.M.’s institution has received compensation for lecture honoraria and travel expenses, participation in scientific meetings, clinical trial steering committee membership, or clinical advisory board participation in recent years from Abbvie, Actelion, Alexion, Astrazeneca, Autolus, Bial PD, Biogen, Bristol-Myers Squibb/Celgene, ECTRIMS, EMD Serono, Excemed, Genzyme, Hoffmann-La Roche, Immunic Therapeutics, Indivi, Janssen Pharmaceuticals, Juvisé Pharmaceutical, Lilly, Medday, Medscape, Merck, Merz Therapeutics, the MS International Federation, Mylan-Viatris, the National MS Society, Nervgen, Neuraxpharm, Novartis, Peervoice, Rewind Therapeutics, Samsung-Biosys, Sandoz, Sanofi-Genzyme, Teva Pharmaceutical, TG Therapeutics and Zenas Biopharma or their affiliates.

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Pappolla, A., Arrambide, G. & Montalban, X. A paradigm shift away from dissemination in time in multiple sclerosis. Nat Rev Neurol (2025). https://doi.org/10.1038/s41582-025-01138-y

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