Biology:Schumacher criteria
This article is missing information about dates of when these criteria were introduced and when they became obsolete.October 2018) ( |
Schumacher criteria | |
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Medical diagnostics | |
Purpose | used to identify MS |
Schumacher criteria are diagnostic criteria that were previously used for identifying multiple sclerosis (MS). Multiple sclerosis, understood as a central nervous system (CNS) condition, can be difficult to diagnose since its signs and symptoms may be similar to other medical problems.[1] 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).
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, and that sensitivity and specificity should be calculated for any given criteria[2][3]
Context
Historically, the first widespread set of criteria were the Schumacher criteria (also spelled sometimes Schumacker). Currently, testing of cerebrospinal fluid obtained from a lumbar puncture can provide evidence of chronic inflammation of the central nervous system, looking for oligoclonal bands of IgG on electrophoresis, which are inflammation markers found in 75–85% of people with MS.,[2][4] but at the time of Schumacher criteria, oligoclonal bands tests were not available, and they also lacked MRI.
The most commonly used diagnostic tools at that time were evoked potentials. The nervous system of a person with MS responds less actively to stimulation of the optic nerve and sensory nerves due to demyelination of such pathways. These brain responses can be examined using visual and sensory evoked potentials.[5]
Therefore, clinical data alone had to be used for a diagnosis of MS. Schumacher et al. proposed three classifications based in clinical observation: CDMS (clinically definite), PrMS(probable MS) and PsMS(possible MS).[6]
Summary
To get a diagnosis of CDMS a patient must show the following:[7]
- Clinical signs of a problem in the CNS
- Dissemination in space, shown by clinical evidence of damage in two or more areas of CNS.
- Evidence of white matter involvement
- Dissemination in time shown by one of these: Two or more relapses (each lasting ≥ 24 hr and separated by at least 1 month) or disability 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 should exist
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 McDonald criteria in the form that "no better explanation should exist for MRI observations"
Influence
These criteria were later substituted by Poser criteria and McDonald criteria.[8] Poser criteria introduced the CNS oligoclonal bands into the diagnosis criteria, while McDonald criteria focus on a demonstration with clinical, laboratory and radiologic data of the dissemination of MS lesions in time and space for non-invasive MS diagnosis. All the later criteria were heavily influenced by the original Schumacher work.[citation needed]
References
- ↑ "The differential diagnosis of multiple sclerosis: classification and clinical features of relapsing and progressive neurological syndromes". Neurol. Sci. 22 (Suppl 2): S98–102. November 2001. doi:10.1007/s100720100044. PMID 11794488. http://multiplesclerosislifeinsurance.com/wp-content/uploads/The_differential_diagnosis_of_multiple_sclerosis.pdf.
- ↑ 2.0 2.1 Ann. Neurol. 50 (1): 121–7. July 2001. doi:10.1002/ana.1032. PMID 11456302.
- ↑ "Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria"". Ann. Neurol. 58 (6): 840–6. December 2005. doi:10.1002/ana.20703. PMID 16283615.
- ↑ "Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness". J. Neuroimmunol. 180 (1–2): 17–28. November 2006. doi:10.1016/j.jneuroim.2006.07.006. PMID 16945427.
- ↑ "Practice parameter: the usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 54 (9): 1720–5. May 2000. doi:10.1212/WNL.54.9.1720. PMID 10802774.
- ↑ Problems of Experimental Trials of Therapy in Multiple Sclerosis: Report by the Panel on the Evaluation of Experimental Trials of Therapy in Multiple Sclerosis. 122. March 1965. pp. 552–568. doi:10.1111/j.1749-6632.1965.tb20235.x. PMID 14313512. Bibcode: 1965NYASA.122..552S.
- ↑ Paul O'Connor, James Marriott, Multiple Sclerosis, Chapter 2, Differential Diagnosis and Diagnostic Criteria for Multiple Sclerosis: Application and Pitfalls
- ↑ "Diagnostic criteria for multiple sclerosis: an historical review". Clin Neurol Neurosurg 106 (3): 147–58. June 2004. doi:10.1016/j.clineuro.2004.02.004. PMID 15177763.
![]() | Original source: https://en.wikipedia.org/wiki/Schumacher criteria.
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