Poser criteria
Poser criteria are diagnostic criteria for multiple sclerosis (MS). They replaced the older Schumacker criteria,[1] and now they are considered obsolete as McDonald criteria have superseded them. Nevertheless, some of the concepts introduced have remained in MS research, like CDMS (clinical definite MS), and newer criteria are often calibrated against them.[2]
The article that introduced them also defined the concepts of attack, historical information, clinical evidence, paraclinical evidence, lesion typical of MS, remission, separate lesions and laboratory support, which are necessary to apply the criteria.
The authors defined a set of rules that can yield five conclusions:[3] CDMS, LSDMS, CPMS, LSPMS or noMS. Poser diagnosis of CDMS is known to have a sensitivity of 87% respect postmortem autopsy examination[4]
Definitions
Poser et al. define several concepts. The most important for diagnosis are:
- Attack: Occurrence of a symptom of neurological dysfunction 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:
- CDMS – Clinically definite MS. Needs two attacks and some clinical or paraclinical evidences
- LSDMS – Laboratory supported definite MS, showing oligoclonal bands and clinical or paraclinical evidences
- CPMS – Clinically probable MS, with less restrict combinations.
- LSPMS – Laboratory supported probable MS. Only two attacks is enough to enter this category
- No MS – There is no clinical evidence of having MS.
Summary of requirements
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.
Sensitivity and specifity
Poser diagnosis of CDMS was initially reported to have a sensitivity of 87% respect postmortem autopsy examination.[5] Poser criteria were published in 1983 and their sensitivity increased with time. For example, in 1988 a 94% specifity vs. postmortem analysis was reported [6]
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 classification.
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".[7] "Preclinical MS" refers to cases after the CIS but before the confirming second attack.[8] After the second confirming attack the situation is referred to as CDMS (clinically defined multiple sclerosis).[9]
References
- ↑ SCHUMACKER GA, BEEBE G, KIBLER RF, KURLAND LT, KURTZKE JF, MCDOWELL F, NAGLER B, SIBLEY WA, TOURTELLOTTE WW, WILLMON TL. PROBLEMS OF EXPERIMENTAL TRIALS OF THERAPY IN MULTIPLE SCLEROSIS: REPORT BY THE PANEL ON THE EVALUATION OF EXPERIMENTAL TRIALS OF THERAPY IN MULTIPLE SCLEROSIS. Ann N Y Acad Sci. 1965 Mar 31;122:552–568.
- ↑ Christopher J. Lisanti, Patrick Asbach, and William G. Bradley, Jr. The Ependymal “Dot-Dash” Sign: An MR Imaging Finding of Early Multiple Sclerosis, AJNR Am J Neuroradiol 26:2033–2036, September 2005
- ↑ Poser CM, Paty DW, Scheinberg L, et al. (March 1983). "New diagnostic criteria for multiple sclerosis: Guidelines for research protocols". Annals of Neurology 13 (3): 227–31. doi:10.1002/ana.410130302. PMID 6847134.
- ↑ Izquierdo G, Hauw J-J, Lyon-Caen O, et al: Value of multiple sclerosis diagnostic criteria: 70 Autopsy-confirmed cases. Arch Neurol 1985;42:848-850.
- ↑ Izquierdo G, Hauw J-J, Lyon-Caen O, et al: Value of multiple sclerosis diagnostic criteria: 70 Autopsy-confirmed cases. Arch Neurol 1985;42:848-850.
- ↑ A clinico-pathoanatomical study of multiple sclerosis diagnosis, Engell T. Acta Neurol Scand. 1988 Jul;78(1):39-44. PMID 3176880
- ↑ Hakiki B, Goretti B, Portaccio E, Zipoli V, Amato MP. (2008). "Subclinical MS: follow-up of four cases". European Journal of Neurology 15 (8): 858–61. doi:10.1111/j.1468-1331.2008.02155.x. PMID 18507677.
- ↑ 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.
- ↑ Frisullo G, Nociti V, Iorio R, et al. (Dec 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): 126–134. doi:10.1016/j.jneuroim.2008.09.003. PMID 18926576.
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