Diagnostic criteria of multiple sclerosis

The MS diagnostic criteria are used in neurology to diagnose multiple sclerosis . The main principle of an MS diagnosis is the detection of a spatial and temporal dispersion (dissemination) of inflammatory and destructive foci (also known as plaques) in the central nervous system .

Historically, there are four significant, more precise elaborations of the diagnostic criteria, the change of which reflects the entry of new examination techniques into MS diagnostics. The Schumacher criteria of 1965 and the Rose criteria of 1976 were based primarily on anamnestic and clinical-neurological findings. The 1983 Poser criteria also included findings that can be obtained by examining the cerebrospinal fluid ( liquor cerebrospinalis ). The McDonald Criteria published in 2001 emphasized the importance of the imaging findings of the MRI examination. In 2005 these criteria were revised again. They have since been referred to as the "revised McDonald criteria".

Diagnostic criteria according to Rose 1976

In accordance with these rules, criteria for an unambiguous, a probable and a possible clinical diagnosis were established. The unambiguous clinical diagnosis is based on the evidence of a typical course of disseminated lesions in younger adult patients. The likely diagnosis may be made upon evidence of a relapse with a documented, common symptom. A possible diagnosis may be made when a disease flare-up is documented, but the symptoms cannot be clearly assigned to a central lesion.

Diagnostic criteria according to Poser 1983

A more recent diagnostic algorithm also stipulated that a reliable clinical diagnosis could be made if this can be supported by laboratory findings (MRI, CSF and EP). Accordingly, a reliable clinical diagnosis can be made if two disjoint central lesions are found either over time or as part of a current examination. If only one lesion is found clinically, a reliable diagnosis can also be made if a second lesion can be detected by laboratory tests (EP or MRI): e.g. E.g. paraspasticity of the legs and pathological VEPs ( visual evoked potentials ). The CSF findings should always be pathological.

2001 McDonald Criteria and their 2005 and 2010 revision

In 2001, an international panel of experts proposed new criteria for diagnosing MS that emphasized the importance of imaging findings ( MRI ) in addition to clinical findings (McDonald criteria). Paraclinical findings ( CSF diagnostics and evoked potentials ) were also taken into account; however, they lost importance compared to imaging findings. Based on studies that looked at the sensitivity and specificity of the McDonald criteria, a revision was made in 2005 and 2010. Overall, these revised McDonald criteria are characterized by a simplified diagnosis of MS. It is important to note that the diagnosis of MS must not be made if the pathological findings can be better explained by another disease.

The following table shows the exact version of the revised McDonald criteria:

Clinical presentation	Additional parameters that are required for an MS diagnosis
* Two or more relapses. * Two or more objectifiable clinically evident lesions	No; clinical evidence is sufficient
* Two or more relapses * An objectifiable, clinically evident lesion	Dissemination in the room, detection by: * MRI * or a positive CSF finding plus two or more MS-typical MRI lesions * or waiting for another flare-up caused by a lesion in a different location
* One flare * Two or more objectifiable clinically evident lesions	Dissemination in time, as evidenced by: * MRI * or second clinical episode
* A burst * An objectifiable clinically evident lesion (monosymptomatic presentation, clinically isolated syndrome )	Dissemination in space, evidence through: * MRI * or positive CSF findings plus two or more MS-related MRI lesions and dissemination in time, evidence through: * MRI * or second clinical episode
Creeping Neurological Progression (PP-MS)	Continuous clinical progression (determined retrospectively or prospectively) over one year and two of the following points apply: * positive MRI of the brain (nine T2 lesions or four or more T2 lesions with positive VEP) * positive MRI of the spinal cord (two or more T2 lesions) * positive CSF finding

If the criteria are met and there is no better explanation for the clinical presentation, the diagnosis is MS. If it is suspected but the criteria are not fully met, the diagnosis is possible MS . If during the diagnostic process another diagnosis better explains the clinical presentation findings, the diagnosis is not MS .

In 2010, the McDonald criteria were revised again:

Number of thrusts	Number of clinical lesions	Further requirements for diagnosis MS
2 and more	2 and more	no
2 and more	1	Missing: spatial dissemination, fulfilled MR tomographically if: 1 or more T2 lesions in at least two of the MS-typical regions (periventricular, juxtacortical, infratentorial , spinal) OR waiting for a new flare-up with a new lesion location
1	2 and more	Missing: temporal dissemination; MR-tomographically fulfilled in: Simultaneous detection of asymptomatic gadolinium-absorbing and non-absorbing lesions, OR detection of a new T2 or gadolinium-absorbing lesion in the control MRI independent of time, OR waiting for a new episode
1	1	Missing: spatial and temporal dissemination, MR-tomographic requirements see above
Neurological progression with suspected primary chronic progressive MS		At least 1 year of progression plus 2 of the following 3 criteria: 1. 1 or more T2 lesions in the MS-typical regions periventricular, juxtacortical, infratentorial 2. 2 or more spinal lesions 3. Evidence of intrathecal IgG synthesis

References and comments

1. ↑ Schumacher et al .: 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 NY Acad Sci. 1965 Mar 31; 122: 552-68. doi : 10.1111 / j.1749-6632.1965.tb20235.x . PMID 14313512 .
2. ↑ Rose A et al .: Criteria for the clinical diagnosis of multiple sclerosis. Neurology. 1976; 26: 20-2. PMID 58393
3. ↑ Poser et al .: New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol. 1983 Mar; 13 (3): 227-31. PMID 6847134
4. ^ Rose AS, Ellison GW, Myers LW, Tourtellotte WW. Criteria for the clinical diagnosis of multiple sclerosis. Neurology. 1976 Jun; 26 (6 PT 2): 20-2. PMID 58393
5. ^ 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. Ann Neurol. 1983 Mar; 13 (3): 227-31. PMID 6847134
6. ↑ Poser CM, Paty DW, Scheinberg L, McDonald WI, Ebers GC: The Diagnosis of Multiple Sclerosis New York: Thieme-Stratton, 1984. Quoted from Lewis P. Rowland. Merrits Textbook of Neurology Williams and Wilkins.
7. ↑ McDonald WI et al .: Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001 Jul; 50 (1): 121-7. PMID 11456302
8. ↑ Polman CH et al .: Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol. 2005 Dec; 58 (6): 840-6. PMID 16283615
9. ^ Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. Ann Neurol. 2011; 69: 292-302
10. ↑ Overview of the changes to the revised version of the McDonald criteria at the DMSG ( Memento of the original of October 13, 2007 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.  
11. ↑ Evidence of spatial dissemination by means of MRI is provided if three of the following four characteristics are met: 1. At least one gadolinium-absorbing lesion or nine lesions that are hyperintense on the T2-weighted image if there is no gadolinium-absorbing lesion. 2. At least one lesion below the cerebellar tentorium (infratentorial). 3. At least one lesion immediately on the cortical ligament (juxtacortical). 4. At least three periventricular lesions.
12. ↑ A positive CSF finding is the detection of an intrathecal (located within the subarachnoid space ) production of antibodies (this can be done by displaying oligoclonal bands only in the CSF using isoelectric focusing or using an increased IgG index in the ratio diagram according to Reiber )
13. ↑ Detection of temporal dissemination using MRI can be done in two ways: 1. Detection of a gadolinium- absorbing lesion no earlier than three months after the occurrence of the initial clinical event. The new lesion must not be located in a location that corresponds to the initial clinical event. 2. Detection of a new T2 lesion at any point in time in an MRI image compared to a reference image. This reference exposure should have been made at least 30 days after the initial clinical event.

literature

• Thomas Brandt, Johannes Dichgans, Hans-Christoph Diener: Therapy and course of neurological diseases. Kohlhammer, Stuttgart 2007, ISBN 3-17-019074-1 .
• Rudolf M. Schmidt, Frank Hoffmann: Multiple sclerosis. Urban & Fischer, Munich 2006, ISBN 3-437-22081-0 .

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