New diagnostic criteria for multiple sclerosis: Guidelines for research protocols

Abstract

Several schemes for the diagnosis and clinical classification of multiple sclerosis (MS) have been advanced [l}. The best known is that published by Schumacher et alC31. The criteria for this scheme were established in order to select patients for participation in therapeutic trials, and pertain only to what might be called definite MS. No provision was made for incorporating supportive laboratory data into the diagnostic criteria.As no reliable specific laboratory test for the diagnosis of MS has been discovered, the diagnosis remains a clinical one, and there is still a need for clinical diagnostic criteria. However, several laboratory and clinical procedures have been developed within the last decade which aid greatly in demonstrating neurological dysfunction attributable to lesions, and even the lesions themselves.One problem with the various published diagnostic classifications is their discrepant terminology: what is considered "probable" in one is called "definite" in another. Another problem is that all the proposed schemes require much subjective judgment, a difficulty which cannot be completely overcome but can be diminished by adding to the clinical evaluation the results of laboratory, neuroimaging, neuropsychological, and neurophysiological procedures. Today there is a need for more exact criteria than existed earlier in order to conduct therapeutic trials in multicenter programs, to compare epidemiological surveys, to evaluate new diagnostic procedures, and to estimate the activity of the disease process in MS. Method and ProcedureOn April 26 and 27, 1982, the following persons participated The participants reviewed in detail historical and clinical symptomatology in MS; immunological observations; cerebrospinal fluid (CSF) tests; neurophysiological procedures including visual, brainstern auditory, trigeminal, and somatosensory evoked potential measurements; the evoked blink reflex; a variety of physiological and psychophysiological procedures; neuropsychological assessment; tissue imaging procedures such as computer assisted tomography (CT scanning) and nuclear magnetic resonance (NMR); and urological studies of bladder, bowel, and sexual dysfunction. This re-~

Long‐term evolution of multiple sclerosis disability in the treatment era

“…Survival analysis was used to generate Kaplan-Meier estimates for time to EDSS=6 and SPMS in the subgroup of patients meeting criteria for CDMS. 34 Logistic regression was used to determine whether baseline clinical, radiologic and genetic features of this cohort correlated with long-term disability, and to model clinical and MRI changes from baseline to year 2 and escalation therapy as predictor variables for long-term disability outcomes. To maintain homogeneity of cohort time for the logistic regression analysis, subjects without year 10 follow-up visits were removed.…”

“…Disease duration in years is graphed on the x-axis and the percentage of the cohort at each time point that has not met the failure events is depicted on the y-axis. For this analysis, subjects in our cohort were limited to those meeting criteria for clinically definite MS. 34 Subjects who had one relapse and who met International Panel criteria for dissemination over time by MRI criteria at baseline (n=19) but did not experience further clinical events over the course of follow-up were excluded (n=10). Similarly, CIS subjects who did not experience further clinical relapses or disease progression (n=48) were excluded.…”

Long‐term epidemiology of multiple sclerosis in the N orthern S eville D istrict

“…The diagnosis of MS was made/confirmed by the study investigators (Dr. Izquierdo and Dr. Navarro) based on history taking, clinical criteria, magnetic resonance imaging (MRI) criteria (including evoked responses) and testing of CSF for IgG synthesis (Tibbling/Link index) and OCB, and verified using the criteria of Poser et al. 14. If some other diagnosis could explain the clinical symptoms, the patient was excluded from the study.…”

The effect of interferon beta-1b on size of short-lived enhancing lesions in patients with multiple sclerosis

“…The review board of the National Institute of Neurological Disorders and Stroke approved the study and all participants gave written informed consent. The study relied on the retrospective analysis of monthly MRIs of 30 patients with RRMS according to Poser's criteria [23] consecutively enrolled in an observational study at NIH. At the time of the study's first MRI, none of the patients had been treated with any other immunomodulatory therapy.…”