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  • Clinical Outlook
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Implementation of the 2024 revision of the McDonald criteria for multiple sclerosis

Nature Reviews Neurology volume 21, pages 664–666 (2025)Cite this article

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The 2024 revision of the McDonald criteria for diagnosis of multiple sclerosis marks a substantial departure from previous iterations, establishing a unified framework that integrates presentation, lesion topography and a flexible combination of paraclinical tools. This Clinical Outlook considers the major changes and their clinical implementation, and the implications of the new criteria.

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Fig. 1: Approach to the diagnosis of multiple sclerosis (MS) with the 2024 revision of the McDonald criteria.

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Acknowledgements

M.M. has received research grants from Ministero Università e Ricerca - Piano Nazionale di Ripresa e Resilienza Extended Partnerships (MNESYS No. PE00000006 and DHEAL-COM No. PNC-E3- 2022–23683267) and Campania Region NeuroDiaTE Project (CUP E65E24002260002); and is editorial board member of Neurology and Multiple Sclerosis Journal. O.C. has a National Institute for Health and Care Research (NIHR) Research Professorship (RP-2017-08-ST2-004); is Deputy Editor of Neurology, for which she receives an honorarium; and has received research grant support from the MS Society of Great Britain and Northern Ireland, the National MS Society, the NIHR Health Technology Assessment Programme, the NIHR University College London Hospitals Biomedical Research Centre and the Rosetree Trust.

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Authors and Affiliations

  1. Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy

    Marcello Moccia

  2. Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy

    Marcello Moccia

  3. Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK

    Marcello Moccia, Olga Ciccarelli & Alan Thompson

  4. National Hospital for Neurology and Neurosurgery, London, UK

    Olga Ciccarelli

  5. National Institute for Health and Care Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK

    Olga Ciccarelli & Alan Thompson

Authors
  1. Marcello Moccia
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  2. Olga Ciccarelli
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  3. Alan Thompson
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Corresponding author

Correspondence to Marcello Moccia.

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Competing interests

M.M. has received honoraria from Abbvie, Biogen, BMS Celgene, Ipsen, Janssen, Merck, Novartis, Roche and Sanofi-Genzyme. O.C. is a member of an independent data and safety monitoring board for Novartis; has given a teaching talk in a local symposium for Merck; and has contributed to an advisory board for Biogen. A.T. declares no competing interests.

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Moccia, M., Ciccarelli, O. & Thompson, A. Implementation of the 2024 revision of the McDonald criteria for multiple sclerosis. Nat Rev Neurol 21, 664–666 (2025). https://doi.org/10.1038/s41582-025-01141-3

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