Diagnostic criteria for MS
Medical organizations have created diagnostic criteria to ease and standardize the diagnostic process especially in the first stages of the disease. Schumacher criteria were the first internationally recognized criteria for diagnosis, and introduced concepts still in use, as CDMS (Clinically definite MS).
Since then, other diagnosis criteria have been proposed. Among them, Poser criteria and McDonald criteria.
Sometimes it has been stated that the only proved diagnosis of MS is autopsy, or occasionally biopsy, where lesions typical of MS can be detected through histopathological techniques,[1][2] Nevertheless, small lesions are invisible under MRI. Therefore, including clinical observations still yield a more accurate MS diagnosis than MRI alone.
Contents
Schumacher criteria
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To get a diagnosis of CDMS a patient must show the following:[3]
- Clinical signs of a problem in the CNS
- Evidence of two or more areas of CNS involvement
- Evidence of white matter involvement
- One of these: Two or more relapses (each lasting ≥ 24 hr and separated by at least 1 month) or progression (slow or stepwise)
- Patient should be between 10 and 50 yr old at time of examination
- 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
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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
Barkhof criteria,[4] later modified by Tintoré[5] 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
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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
Published by D.T.Okuda mainly for research in MS, these criteria define what should be considered a Radiologically Isolated Syndrome (RIS)[6]
References
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- ↑ Paul O'Connor, James Marriott, Multiple Sclerosis, Chapter 2, Differential Diagnosis and Diagnostic Criteria for Multiple Sclerosis: Application and Pitfalls
- ↑ 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.
- ↑ 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
- ↑ D. T. Okuda et al. Incidental MRI anomalies suggestive of multiple sclerosis, Neurology March 3, 2009 vol. 72 no. 9 800-805
- ↑ Basic Pathology - Robbins et al - 9th edition
