Újdonságok a sclerosis multiplex diagnózisában: a 2024-es McDonald-kritériumok áttekintése

Background and purpose: The diagnostic criteria for multiple sclerosis have changed several times in recent decades, aiming to detect the disease as early as possible while reducing the risk of misdiagnosis. Since the introduction of the last 2017 criteria, significant progress has been made in several areas, the need for further modifications has arisen. Methods: The new criteria, compiled through consensus recommendations, was presented in 2024 and published in October 2025. Separate manuscripts were dedicated to presenting the role of the most important paraclinical tests. Hereby we present the summary of the most important novelties regarding the 2024 McDonald diagnostic criteria. Results: During the compilation, participants insisted on two general aspects: the criteria should be applicable worldwide and paraclinical tests should play an essential role in diagnostics. Detection of characteristic MRI lesions continues to be fundamental in the diagnosis. The inclusion of the optic nerve as a fifth anatomical region and the detection of the central vein sign and paramagnetic rim lesion reduce the risk of misdiagnosis, while the kappa free light chain index can be used to substitute for oligoclonal gammopathy in establishing the diagnosis. By developing a unified biological framework, patients with different disease courses, and under appropriate conditions, patients with atypical symptoms or asymptomatic individuals with radiologically isolated syndrome can also be diagnosed with multiple sclerosis. The recommendations related to older age and comorbidities are primarily helpful in differential diagnosis. Conclusion: Periodic updating and standardization of diagnostic criteria and the use of biomarkers can facilitate the diagnostic process, provide opportunity for early initiation of therapy, and influence the later quality of life of patients with multiple sclerosis.