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The fourth update of the McDonald criteria enables an earlier diagnosis of MS in people presenting with typical symptoms. It broadens MRI evidence for dissemination in space to include symptomatic and cortical lesions and allows dissemination in time to be demonstrated by unmatched oligoclonal bands in the CSF as well as by new or enhancing MRI lesions. To avoid misdiagnosis, it should be used with caution in patients with atypical symptoms or in populations in which MS is uncommon.