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    Question about the old Poser Criteria for MS

    I've come across a wiki entry for the Poser Criteria which was the one used before McDonald and this would have been used when I first had symptoms. I don't understand what is meant by the criteria of:-

    "Paraclinical evidence: Demonstration by any test of the existence of a non-clinical lesion in the CNS"

    Does this mean any one of a number of tests giving an abnormal result or does it mean an additional lesion that isn't showing physical symptoms yet but is showing up on a test? or is it something else?

    Im also not sure what a lesion is - is that inflammation?

    I'm not familiar with medical terms so any insights would be very much appreciated.
    Thanks

    #2
    Hello Spuds,

    Im also not sure what a lesion is - is that inflammation?
    This link explains lesions related to Multiple Sclerosis:
    http://www.my-ms.org/ms_what_is.htm

    I don't understand what is meant by the criteria of:-
    "Paraclinical evidence: Demonstration by any test of the existence of a non-clinical lesion in the CNS"
    I do not have a medical back ground so I cannot answer this question...sorry. Hopefully someone else will be able to explain.

    However, I was diagnosed under the Poser Criteria. My diagnosis was based on Neurological exam, symptoms and a positive Lumbar Puncture. All other tests including the MRI was clear (normal).
    Diagnosed 1984
    “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

    Comment


      #3
      Poser Criteria

      The 1990s 0.75 MRIs became available for wide variety of medical and hospitals and it made thins a lot of things more easy to see, not least of it was illumination and showing of objects that did not see. Now we have the 3T machines hospitals are going this way and they show much more lesions if you have them. Anyway the poser criteria relied my on physical complaints than technical complaints that you have to pass these days with the revised 2010 McDonald Criteria which is most tougher to pass.

      It is difficult to diagnose without a good MRI. However the thing s they would look for would by nystagmus, Babinski sign, to a lesser degree Hoffmens sign. You can googl! Spaticity was a suppo r ting. There are other basic neurological exam.

      It is good that we have the new criteria as it weeds out false positive. Some people have to wait a little longer, but give it tif it is truly MS it will show in good time. You almost need a weakness attack to ansure you know you have a new kesion.

      Take care

      Lisa
      Last edited by 22cyclist; 08-22-2015, 08:29 PM.
      Disabled RN with MS for 14 years
      SPMS EDSS 7.5 Wheelchair (but a racing one)
      Tysabri

      Comment


        #4
        Originally posted by Spuds View Post
        I've come across a wiki entry for the Poser Criteria which was the one used before McDonald and this would have been used when I first had symptoms. ... I'm not familiar with medical terms so any insights would be very much appreciated.
        Thanks
        Hi Spuds:

        Sometimes terms are used for more than one thing and definitions depend on the context, and sometimes definitions overlap, so sometimes it can be hard to come up with a succinct, all-encompassing definition. But I hope this will clarify some of the terminology for you.

        I'd also like to talk about the Poser criteria.

        Originally posted by Spuds View Post
        Im also not sure what a lesion is - is that inflammation?
        “Lesion” is a general term for anything in a biological system that’s not supposed to be there or wouldn’t be there under normal circumstances.

        For example, if you get a cut on your arm, the cut is a lesion. After the cut heals, the scar is a lesion. A physical injury is a lesion. A pimple on your chin is a lesion. A rash is a lesion. A stomach ulcer is a lesion. A tumor is a lesion.

        “Lesion” is not something special that occurs only in MS, as many people with MS wrongly believe.

        In MS, there are two kinds of lesions:
        1) An area of active inflammation anywhere in the central nervous system that affects the health and function of the affected nerves and surrounding cells.
        2) The damaged nerve tissue, including scarring, that remains after the inflammation has resolved.

        Depending on where the lesion in the central nervous system is and how big it is, it may or may not result in visible signs (something that can be seen) or symptoms (something that the person feels that no one else can experience).

        Originally posted by Spuds View Post
        I don't understand what is meant by the criteria of:
        "Paraclinical evidence: Demonstration by any test of the existence of a non-clinical lesion in the CNS"

        Does this mean any one of a number of tests giving an abnormal result or does it mean an additional lesion that isn't showing physical symptoms yet but is showing up on a test? or is it something else?
        Here’s another term: criteria. Criteria is a plural noun, meaning more than one criterion, or standard of classification. In this case, paraclinical evidence is one criterion of many more that make up the Poser criteria.

        Clinical evidence refers to what a doctor can see or make a decision about in the office or clinic. The definition gets a little loose here because, as technology and medicine have advanced, clinical evidence now can include all kinds of laboratory and electronic tests that are done outside the office or clinic. Earlier, clinical evidence didn’t include some testing that was done outside the office (like MRI) and was considered to be paraclinical evidence.

        “Para-“ means next to or beside. Paraclinical refers to other tests or information that occurs next to or beside what the doctor sees or tests in the office.

        In the case of the Poser criteria, paraclinical evidence refers to evidence obtained outside the regular office exam. It includes tests like MRI, nerve conduction tests, evoked potentials tests, even the old “hot bath” test that evaluated for Uhthoff’s phenomenon (weakness in the presence of heat). Paraclinical evidence includes information that indicates the presence of lesions that the doctor can’t necessarily identify with standard in-office testing or the presence of lesions that aren’t causing the symptoms of the current attack.

        A non-clinical or para-clinical lesion refers to a lesion that isn't causing the symptoms of the current attack.

        Under the Poser criteria for clinically definite MS, there must be one item of clinical evidence and one item of paraclinical evidence. For example, the clinical evidence might be an afferent pupillary defect related to optic neuritis and the paraclinical evidence might be abnormalities on an MRI of the brain.

        This is important:

        You said in another thread that you started having neurological symptoms about 30 year ago. With that review of the Poser criteria, which were in effect at the time, it’s important to go back to the understanding that technology has changed many things about the way medicine is practiced. Because of that, it’s misleading to try to judge 1985 criteria by 2015 standards.

        In 1985, MRI was just beginning to be used in neurology and the diagnosis of MS. It was still a primitive technology, and there was discussion and dissent about the significance of MRI in diagnosing and managing MS. Since the 2010 revision of the McDonald criteria, MRI has become so important in MS that it has become extremely difficult (at least in developed countries) for anyone to get a diagnosis of MS without MRI evidence. And without MRI evidence there must be other well-explained and documented evidence to support the diagnosis, such as positive evoked potentials and LP.

        It’s said that MS is a clinical diagnosis. But with the technology available now, clinical evidence includes electrodiagnostic and other testing that wasn’t included earlier under the umbrella of "clinical." One indication of that is that the McDonald diagnostic criteria in about 2000 eliminated the whole concept of “paraclinical.” Nowadays, if the information is available through established medical channels, it’s usable and considered to be “clinical.”

        It’s virtually impossible for a diagnosis of MS to be made now without some kind of technological evidence. Differential diagnoses depend on it. 30 or 40 years ago, in the absence of other kinds of evidence besides some general neurological signs and symptoms, a doctor could just say, “Well, I don’t know what it is so I’ll call it MS.” That isn’t done anymore.

        It’s also important to remember how rare MS was 30 or 40 years ago. Doctors really didn’t know much about it, and without the technology we have today, there wasn’t much that could be known about it. So the only doctors paying attention to MS diagnostic criteria were the few who were interested in MS. Uninterested doctors weren’t using diagnostic criteria. Even in 2015, uninterested neurologists still don’t.

        At the time of the Poser criteria, those doctors who didn’t have interest or experience with MS didn’t know how to diagnose it so sometimes just didn’t.

        Another thing that’s important to remember is that effective treatments for MS have been around for only about 20 years. So before about 1995, some doctors felt that, since there was no treatment for MS, it wouldn’t do the patient any good to be diagnosed with a disease that had no treatment. So before about 1995, some doctors simply didn’t make a diagnosis of MS.

        This is also important:

        It has been found that the greatest amount of damage in MS occurs in the early years. So by the time treatments became available in the mid to late 1990s, anyone who had been diagnosed with MS before about 1990 would already have incurred damage from MS, and many of them would already have been beyond the help that the relatively low-effectiveness drugs would have provided them.

        So if you’re trying to find evidence that your doctor could have diagnosed you with MS back in 1985 and didn’t, the chances are high that it wouldn’t have made much difference. There were no treatments available at the time and wouldn’t be for about 10 more years.

        If you have MS and did back in 1985, you would already have incurred 10 years or more of damage by the time there were any treatments available. MS treatment medications don’t undo existing damage. And those early drugs have an effectiveness rate of about 30%. So there’s also a chance that they wouldn’t have been of much help.

        Putting 10 years of existing damage together with a low-effectiveness medication that can't undo damage doesn’t present a picture that anything would have turned out significantly different for you even if you had been diagnosed back in 1985. If you’re seeing, or are going to see, an MS specialist, this would be a good topic for you to discuss with the doctor.

        I hope that I’ve been able to clear up some of the terminology for you, but also to put the Poser criteria into better perspective. With concepts that are obsolete and terminology that is overlapping and evolving, someone else might explain thing differently.

        Comment


          #5
          Originally posted by 22cyclist View Post
          The 1990s 0.75 MRIs became available for wide variety of medical and hospitals and it made thins a lot of things more easy to see, not least of it was illumination and showing of objects that did not see.
          Lisa
          Lisa, the MRI was being used in 1985...I had one. There were 2 MRI machines in the entire State of Colorado in 1985, one in Colorado Springs and one at the Denver Tech Center.
          Diagnosed 1984
          “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

          Comment


            #6
            Thanks so much Lisa, Snoopy and JR for taking the time and energy to reply to my post :-)

            Thanku JR for all the insights you gave me - a huge weight has been lifted off my shoulders by what you have said about the factthat nothing could have been done anyway if I had have been dx back in 85 and I'm feeling much more positive about it all and am just looking forward from now on :-)

            I'm off to the neuro this week with my bag full of balance issues, inability to walk on my heels or toe to toe, numb breasts (I can stick pins in them and don't go ouch!) and of course my old friend the extra large heavy suitcase filled with 25 years of fatigue will be going too ;-)

            Thanks again,you have all been awesome :-)

            Comment


              #7
              I got my Mri results back this week on my brain and full spine - all normal - which my neuro suspected after my visit last week and so I have been dx with Functional Disorder.

              Comment


                #8
                Hi Spuds,

                Originally posted by Spuds View Post
                I got my Mri results back this week on my brain and full spine - all normal - which my neuro suspected after my visit last week and so I have been dx with Functional Disorder.
                Functional Neurological Disorder(FND) can cause many, many, symptoms and difficulties. Below is an excellent website about FND:
                http://www.fndhope.org/

                Best wishes!
                Diagnosed 1984
                “Lightworkers aren’t here to avoid the darkness…they are here to transform the darkness through the illuminating power of love.” Muses from a mystic

                Comment


                  #9
                  Hi Snoopy!

                  thanks for the info :-)

                  I've enjoyed hanging out with all you guys and wish you all the best of health xoxox

                  Comment

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