Bridging the gap between guidelines and practice: neurologists' readiness for the updated McDonald criteria in Egypt.

BACKGROUND: The McDonald criteria (MC) are fundamental in diagnosing multiple sclerosis (MS). Despite advancements in diagnosis, misdiagnosis remains a persistent challenge. The 2024 MC revisions incorporate new radiological features (central vein sign (CVS), paramagnetic rim lesions (PRLs)) and biomarkers (kappa free light chain (KFLC)) to enhance diagnostic specificity, even in asymptomatic individuals. OBJECTIVE: To explore Egyptian neurologists' understanding of and readiness to implement the updated 2024 MC for multiple sclerosis diagnosis. METHODS: An exploratory cross-sectional, open online survey was conducted among 143 neurologists in Egypt. A 16-item questionnaire assessed their professional background, MS exposure, attitudes towards the updated MC and access to relevant diagnostic and imaging resources. Domain scores for clinical confidence and knowledge/familiarity were computed, and associations with demographic factors were analysed. RESULTS: Most neurologists (98%) actively managed MS cases, and 83% reported familiarity with the updated MC. Clinical confidence scores were moderate overall, whereas knowledge/familiarity scores were generally higher; the two measures were positively correlated (Spearman ρ = 0.24, p=0.02). Knowledge gaps remained: nearly 62% were unfamiliar with PRLs, and 38% were unaware of the CVS. Resource limitations were notable, with 83% lacking access to KFLC testing and 75% limited to 1.5 T MRI machines. CONCLUSION: Egyptian neurologists demonstrate strong engagement with the updated MC; however, limited awareness of novel markers and restricted access to essential diagnostic resources (3 T MRI, KFLC) present barriers to their optimal application.