Poser criteria
Poser criteria are diagnostic criteria for multiple sclerosis (MS). Currently they are considered obsolete as McDonald criteria have superceeded them.
The article that introduced them defined also the concepts of attack, historical information, clinical evidence, paraclinical evidence, lesion typical of MS, remision, separate lesions and laboratory support, which are necessary to apply the criteria.
The authors defined then a set of rules that can yield five conclusions[1]:
Definitions
Poser et al. define several concepts. The most important for diagnosis are:
- Attack: Ocurrence of a symptom of neurological disfunction for more than 24 hours
- Clinical evidence: Neurological dysfunction demonstrable by neurological examination
- Paraclinical evidence: Demonstration by any test of the existence of a non-clinical lesion in the CNS
Diagnosis conclusions
The criteria can yield five conclusions:
- A) CDMS, Clinically definite MS. Needs two attacks and some clinical or paraclinical evidences
- B) LSDMS - Laboratory supported definite MS, showing oligoclonal bands and clinical or paraclinical evidences
- C) CPMS - Clinically probable MS, with less restrict combinations.
- D) LSPMS - Laboratory supported probable MS. Only two attacks is enough to enter this category
- No MS - There is no clinical evicence of having MS.
Summary of requirements
Any of the five conclusions have subposibilities. Here a table is shown with each one of them:
| Clinical Presentation | Additional Data Needed | |
|---|---|---|
| CDMS | * Two or more attacks (relapses) | Two clinical evidence One clinical and one paraclinical evidence |
| LSDMS | * At least one attack and oligoclonal bands | Two attacks and one evidence (clinical or paraclinical) One attack and two clinical evidences One attack, one clinical and one paraclinical evidences |
| CPMS | * At least one attack | Two attacks and one clinical evidence One attack and two clinical evidences One attack, one clinical and one paraclinical evidences |
| LSPMS | * Two attacks | No more evidence is required |
If none of these requirements is accomplished, the diagnosis is "No MS", meaning that there is not enough clinical evidence to support a clinical diagnosis of MS.
Extension of the concepts
As more knowledge about the underlying pathology of MS has been gathered, the concepts of Subclinical, preclinical and CIS have been used together with the Poser original clasification.
The first manifestation of MS is the so called Clinically isolated syndrome, or CIS, which is the first isolated attack. The Poser diagnosis criteria for MS does not allow doctors normally to give an MS diagnosis until a second attack takes place. Therefore the concept of "clinical MS", for a MS that can be diagnosed is sometimes too strong because until MS diagnosis has been established, nobody can tell whether the disease dealing with is MS.
Cases of MS before the CIS are sometimes found during other neurological inspections and are referred to as subclinical MS.[2] Preclinical MS refers to cases after the CIS but before the confirming second attack.[3]. After the second confirming attack the situation is referred to as CDMS (clinically defined multiple sclerosis)[4].
References
- ^ Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW. New diagnostic criteria for multiple sclerosis: guidelines for research protocols[1]. PMID 6847134
- ^ Hakiki B, Goretti B, Portaccio E, Zipoli V, Amato MP. (2008). "Subclinical MS: follow-up of four cases". PMID 18507677.
{{cite journal}}: Cite journal requires|journal=(help)CS1 maint: multiple names: authors list (link) - ^ Lebrun C, Bensa C, Debouverie M; et al. (2008). "Unexpected multiple sclerosis: follow-up of 30 patients with magnetic resonance imaging and clinical conversion profile". J Neurol Neurosurg Psychiatry. 79 (2): 195–198. doi:10.1136/jnnp.2006.108274. PMID 18202208.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Frisullo G, Nociti V, Iorio R; et al. (2008). "The persistency of high levels of pSTAT3 expression in circulating CD4+ T cells from CIS patients favors the early conversion to clinically defined multiple sclerosis". J Neuroimmunol. 205 (1–2): 126–34. doi:10.1016/j.jneuroim.2008.09.003. PMID 18926576.
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