Diagnostic criteria for MS

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Since the first description of Multiple Sclerosis (MS) by Charcot, the Neurological community has been striving to create reliable and reproducible criteria for diagnosis of MS.[1] The first attempts were made by Charcot himself, followed by Marburg and later Allison. The first criteria however were lacking in sensitivity and specificity for clinical use.[1]

The first landmark event in the history of diagnostic criteria for MS was the development of the Schumacher criteria. These were the first internationally recognized criteria for diagnosis of MS and introduced very important diagnostic concepts that are the cornerstone of MS diagnosis nowadays, such as the clinical definition of MS and the requirement of dissemination in time and space for accurate diagnosis.

Since then, other diagnostic criteria have been proposed. Among them, Poser criteria utilized several laboratory and paraclinical studies to enhance the diagnostic accuracy. McDonald criteria, which are the ones used today, successfully introduced MRI findings as surrogates for the criterion of dissemination in time and space when clinical data are lacking, thus allowing earlier diagnosis of MS.[1]

However, the only definite diagnosis of MS is autopsy, where lesions typical of MS can be detected through histopathological techniques.[2][3]

Schumacher criteria[edit]

To get a diagnosis of CDMS a patient must show the following:[4]

  1. Clinical signs of a problem in the CNS
  2. Evidence of two or more areas of CNS involvement
  3. Evidence of white matter involvement
  4. One of these: Two or more relapses (each lasting ≥ 24 hr and separated by at least 1 month) or progression (slow or stepwise)
  5. Patient should be between 10 and 50 yr old at time of examination
  6. No better explanation for patient’s symptoms and signs

The last condition, no better explanation for symptoms, has been heavily criticised, but it has been preserved and it is currently included in the new McDonalds criteria in the form that "no better explanation should exist for MRI observations"

Poser criteria[edit]

Poser criteria can be summarized in this table:

Any of the five conclusions have subpossibilities. 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.

Barkhof-Tintoré criteria[edit]

Barkhof criteria,[5] later modified by Tintoré[6] were an early attempt to use MRI to diagnose MS.

Their observations were taken into account when McDonald criteria were published, and therefore they can be considered deprecated by the latter.

McDonald criteria[edit]

McDonald criteria can be summarize in this table:

Clinical Presentation Additional Data Needed
* 2 or more attacks (relapses)
* 2 or more objective clinical lesions
None; clinical evidence will suffice (additional evidence desirable but must be consistent with MS)
* 2 or more attacks
* 1 objective clinical lesion
Dissemination in space, demonstrated by:
* MRI
* or a positive CSF and 2 or more MRI lesions consistent with MS
* or further clinical attack involving different site
* 1 attack
* 2 or more objective clinical lesions
Dissemination in time, demonstrated by:
* MRI
* or second clinical attack
* 1 attack
* 1 objective clinical lesion
(monosymptomatic presentation)
Dissemination in space demonstrated by:
* MRI
* or positive CSF and 2 or more MRI lesions consistent with MS
and
Dissemination in time demonstrated by:
* MRI
* or second clinical attack
Insidious neurological progression
suggestive of MS
(primary progressive MS)
One year of disease progression (retrospectively or prospectively determined) and

Two of the following:

  a. Positive brain MRI (nine T2 lesions or four or more T2 lesions with positive VEP)
  b. Positive spinal cord MRI (two focal T2 lesions)
  c. Positive CSF

Okuda Criteria[edit]

Published by D.T.Okuda mainly for research in MS, these criteria define what should be considered a Radiologically Isolated Syndrome (RIS)[7]

References[edit]

  1. ^ a b c Ntranos, Achilles; Lublin, Fred (2016-08-22). "Diagnostic Criteria, Classification and Treatment Goals in Multiple Sclerosis: The Chronicles of Time and Space". Current Neurology and Neuroscience Reports. 16 (10): 90. ISSN 1528-4042. doi:10.1007/s11910-016-0688-8. 
  2. ^ McDonald WI, Compston A, Edan G, et al. (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302. doi:10.1002/ana.1032. 
  3. ^ Polman CH, Reingold SC, Edan G, et al. (December 2005). "Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"". Ann. Neurol. 58 (6): 840–6. PMID 16283615. doi:10.1002/ana.20703. 
  4. ^ Paul O'Connor, James Marriott, Multiple Sclerosis, Chapter 2, Differential Diagnosis and Diagnostic Criteria for Multiple Sclerosis: Application and Pitfalls
  5. ^ Barkhof F Filippi M, Miller D, et al: Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis" Brain 1997;120:2059-2069.
  6. ^ Tintoré M, Rovira A, Martínez MJ, et al: Isolated demyelinating syndromes: Comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. AmJ Neuroradiol 2000;21:702-706
  7. ^ D. T. Okuda et al. Incidental MRI anomalies suggestive of multiple sclerosis, Neurology March 3, 2009 vol. 72 no. 9 800-805