Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis

Table 1

McDonald criteria for MS.

Clinical (Attacks)	Objective lesions	Additional requirements to make a diagnosis
Two or more	Two or more, or objective clinical evidence of one lesion with reasonable historical evidence of a prior attack	None
Two or more	One	Dissemination in space, demonstrated by: one or more T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) or await a further clinical attack implicating a different CNS site
One	Two or more	Dissemination in time, demonstrated by: simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time; or A new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan or await a second clinical attack
One (clinically isolated syndrome)	One	Dissemination in space and time, demonstrated by: for DIS: one or more T2 lesion in at least 2 of 4 MS-typical regions of the CNS (periventricular, juxtacortical, infratentorial, or spinal cord) or await a second clinical attack implicating a different CNS site and For DIT: simultaneous presence of asymptomatic gadolinium-enhancing and nonenhancing lesions at any time or a new T2 and/or gadolinium-enhancing lesion(s) on follow-up MRI, irrespective of its timing with reference to a baseline scan or await a second clinical attack
Insidious neurological progression suggestive of MS (PPMS)		One year of disease progression (retrospectively or prospectively determined) plus 2 of 3 of the following criteria: (1) evidence for DIS in the brain based on one or more T2 lesions in the MS-characteristic (periventricular, juxtacortical, or infratentorial) regions,; (2) evidence for DIS in the spinal cord based on tow or more T2 lesions in the cord; (3) positive CSF (isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index)

MS: multiple sclerosis; CNS: central nervous system; MRI: magnetic resonance imaging; DIS: dissemination in space; DIT: dissemination in time; PPMS: primary progressive multiple sclerosis; CSF: cerebrospinal fluid; IgG: immunoglobulin G. (Adapted from Polman et al. [12].)