Criticism
McDonald criteria have been shown to have a low sensitivity and specificity (with respect to the presence of lesions) in Asiatic populations. They present instead a good behaviour (respect CIS to CDMS conversion) when evaluated in non-selected populations.
Some other authors consider McDonald criteria as an attempt for a clinical definition and propose a pathological definition instead. According to Hans Lassmann, the pathological definition should be preferred because the clinical definitions have problems with differential diagnosis. Besides, subclinical MS cases would not be accepted as MS cases by this criteria
Finally McDonald also states "objective evidence of dissemination in time and space of lesions typical of MS is essential in making a secure diagnosis, as is the exclusion of other, better explanations for the clinical features". Therefore, when used as a definition, the McDonald criteria is defining MS just by exclusion of other diseases.
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