New National Multiple Sclerosis Society eLearning program supports implementation of the 2024 McDonald Criteria

Explore the National Multiple Sclerosis Society’s new interactive eLearning program, designed to help clinicians understand and apply the 2024 McDonald Criteria in clinical practice

The 2024 revisions to the McDonald Criteria represent a substantial evolution in the diagnosis of multiple sclerosis (MS). The revised criteria introduce new pathways that aim to enable earlier diagnosis while maintaining specificity, including recognition of the optic nerve as a fifth anatomical location to meet dissemination in space and the incorporation of additional imaging and cerebrospinal fluid (CSF) biomarkers.¹

However, expanding the diagnostic framework also increases the need for clinicians to understand how and when its different components should be applied. To support implementation, the National Multiple Sclerosis Society has launched a new interactive eLearning program aimed at MS specialists and general neurologists. Through case-based learning, interactive imaging exercises, and artificial intelligence (AI)-supported patient simulations, the program provides opportunities for clinicians to apply the revised criteria to realistic diagnostic scenarios and compare the 2024 criteria with their 2017 predecessors.²

Explore the eLearning program

Access the National Multiple Sclerosis Society’s interactive education and resources for applying the 2024 McDonald Criteria in clinical practice.

Applying the 2024 McDonald Criteria in clinical practice

As key contributors to the creation of the elearning programme, touchNEUROLOGY spoke with Dr Andrew Solomon (Larner College of Medicine at the University of Vermont, Burlington, VT, USA) and Dr Daniel Ontaneda (Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and Mellen Center for Multiple Sclerosis, Cleveland, OH, USA) about the practical implications of the 2024 McDonald Criteria and how interactive education could support their implementation in clinical practice.

What do you see as the most important practical changes in the 2024 McDonald Criteria, and how should neurologists adapt their diagnostic approach in everyday practice?

Dr Andrew Solomon: The 2024 revisions provide multiple new pathways to earlier diagnosis of MS. Early diagnosis can improve patient outcomes.

While it is important to understand how the criteria have changed, some of the new approaches to diagnosis may be more or less accessible to individual neurologists. The criteria provide flexibility, allowing neurologists to employ approaches to MS diagnosis that match their expertise and the resources available where they practice.

When evaluating a patient with possible MS, what are the most common pitfalls clinicians should avoid when applying the updated criteria, and how could the eLearning program help?

Dr Andrew Solomon: As with previous MS diagnostic criteria, misunderstanding or misapplication of key elements can result in misdiagnosis.

For example, erroneous ascertainment of fulfillment of dissemination in space (DIS) is common. Given the numerous changes to DIS and how it can be applied within the 2024 criteria, expertise in approaches to DIS for MS diagnosis is particularly important.

The eLearning program provides active learning that can help clinicians understand how to appropriately apply the revisions to the MS diagnostic criteria.

Building diagnostic confidence through interactive learning

What unmet educational need does the National Multiple Sclerosis Society’s interactive learning program address for MS specialists and general neurologists?

Dr Daniel Ontaneda: Whenever diagnostic criteria are updated, it is important to explain not only what has changed, but also how the individual components that make up the criteria have evolved.

MS is ultimately a clinical diagnosis, made by a clinician sitting with a patient, taking a history, reviewing imaging and other investigations, and making a final clinical decision. The diagnostic criteria provide an important framework for this process and help ensure that clinicians around the world diagnose MS according to a consistent international standard.

Whenever new criteria are released, there is naturally a period of adoption. This applies to experienced MS specialists, general neurologists who may see MS less frequently, and trainees learning the criteria for the first time.

One of the important changes in the 2024 criteria is that MS can now be diagnosed in new patient populations. Previously, diagnosis required either a typical clinical attack or progressive neurological symptoms. The updated criteria now provide diagnostic pathways applicable to people with neurological symptoms that are not specific for MS, as well as some individuals with incidental magnetic resonance imaging (MRI) findings suggestive of demyelination who may be asymptomatic or minimally symptomatic.¹

Another important development is the inclusion of additional biomarkers and paraclinical tools that can support diagnosis. These include assessment of the optic nerve using MRI, optical coherence tomography (OCT), and visual evoked potentials; MRI markers including the central vein sign (CVS) and paramagnetic rim lesions (PRLs); and kappa free light chains as an additional CSF marker of intrathecal antibody synthesis.¹

Taken together, these changes alter the overall diagnostic framework. Clinicians need to understand how these new populations, biomarkers, and diagnostic tools fit together when determining whether an individual meets the criteria for MS.

One area we recognized as a particularly important educational need was the introduction of the two new imaging biomarkers: CVS and PRLs. The program therefore includes dedicated training modules using MRI scans from people with MS. Learners can scroll through the scans, identify CVS and PRLs, decide whether a scan is positive or negative, and then receive immediate feedback highlighting the relevant findings.³

I think that is one of the platform’s greatest strengths because it provides clinicians with practical experience in identifying imaging biomarkers that are now incorporated into the updated diagnostic criteria.

The program uses AI-supported patient simulations and case-based learning to compare application of the 2017 and 2024 criteria. How can this approach improve clinicians’ confidence and consistency when diagnosing MS?

Dr Daniel Ontaneda: The published paper contains the information clinicians need to understand the updated criteria, but translating that information into everyday clinical practice can sometimes be difficult.

The National Multiple Sclerosis Society developed the interactive educational program to explain the scientific rationale behind the changes through patient cases because this reflects how we actually apply the criteria in clinical practice.

The program mirrors aspects of a typical outpatient consultation, taking learners through the diagnostic process using realistic patient scenarios.

Advances in educational technology and AI now allow us to create highly interactive learning experiences involving clinical decision-making, imaging, and case progression.

One feature I particularly like is that the program compares the 2024 criteria with the 2017 criteria. For clinicians who know the previous criteria well, this provides a practical way to understand what has changed. Equally, for those learning the criteria for the first time, it provides a clear framework for understanding how an MS diagnosis is reached.

Translating updated criteria into everyday practice

The 2024 McDonald Criteria offer clinicians additional pathways and tools to support earlier diagnosis of MS, including new anatomical, imaging, and CSF components.¹ However, the increasing flexibility of the diagnostic framework also underscores the importance of appropriate application and continued education.

Interactive, case-based education may provide one way to bridge the gap between publication of new diagnostic criteria and their implementation in everyday practice. By allowing clinicians to work through realistic patient scenarios, practice interpretation of newer imaging biomarkers, and compare the 2017 and 2024 frameworks, the National Multiple Sclerosis Society’s eLearning program aims to support greater confidence and consistency in applying the revised criteria across different clinical settings.

Explore the eLearning program

Access the National Multiple Sclerosis Society’s interactive education and resources for applying the 2024 McDonald Criteria in clinical practice.

Prof. Daniel Ontaneda

Daniel Ontaneda, MD, PhD FAAN, is a Professor of Neurology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University and a staff neurologist at the Cleveland Clinic Neurological Institute’s Mellen Center for Multiple Sclerosis, where he also serves as the Director of Research. He serves on the executive committee of the Latin American Committee for Treatment and Research in MS, the Board of the Americas Committee for Treatment and Research in MS, and on the executive committee of the North American Imaging in MS Cooperative. His research is funded by NIH, PCORI, NMSS, UK MS Society, and Race to Erase MS Foundation.

Prof. Andrew J. Solomon

Andrew J. Solomon is Professor of Neurological Sciences and Division Chief of Multiple Sclerosis at the Larner College of Medicine at the University of Vermont, Burlington, VT, USA. His clinical and research work focuses on multiple sclerosis (MS), with particular expertise in MS diagnosis, differential diagnosis and misdiagnosis. He is an investigator on local and national multicentre clinical and translational studies in MS, and has contributed extensively to research and international guidance aimed at improving diagnostic accuracy. His current research focuses on the evaluation of novel imaging and laboratory biomarkers to support earlier and more accurate diagnosis of MS.