Poser criteria
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| Poser criteria | |
|---|---|
| Purpose | Diagnostic criteria for multiple sclerosis |
The Poser criteria are diagnostic criteria for multiple sclerosis (MS). They replaced the older Schumacher criteria.[1] They have in turn been superseded by the McDonald criteria. 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 criteria were unveiled in the Annals of Neurology in 1983 by a team led by Dr. Charles M. Poser.[3]
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.[citation needed]
The criteria considers MS as the presence of demyelinating lesions disseminated in time and space, and they are oriented specially to prove the dissemination. Based on this, 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]
Poser et al. define several concepts. The most important for diagnosis are:[citation needed]
- 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:[citation needed]
- 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:
| Diagnosis conclusion | 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.