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Criterios diagnosticos para Esclerosis Multiple. Una revision historica.

Starting with Charcot, diagnostic criteria for MS have evolved to reflect advances in our understanding of the disease and the development of new diagnostic techniques, and from purely clinical considerations to increasing dependency upon imaging of the central nervous system. The criteria proposed Allison, Marburg, Allison and Millar, Broman et al., Schumacher et al., McAlpine, Lumsden and Acheson, Rose et al., McDonald and Halliday, Bauer, Poser et al. and McDonald et al., as well as the so-called Oriental form of MS proposed by Kuroiwa et al., will be briefly discussed. A numerical scoring system based on sign and symptom frequency in autopsy-proved MS by Poser will be illustrated. The MS diagnostic process was revolutionized by the 1981 introduction of magnetic resonance imaging, but the increasing reliance upon this technique has led to a surge in erroneous diagnoses, mostly because of failure to distinguish between MS and disseminated encephalomyelitis, as well as mounting disregard for the data obtained from the traditional history and physical examination. It has become clear that some important considerations regarding the pathogenesis of MS are based on material of questionable diagnostic accuracy. It is time to decide if we are going to base the diagnosis of MS purely on the MRI, or learn to integrate imaging along with anamnestic and examination information into a more comprehensive clinical diagnostic algorythm. There will never be a substitute for the experienced and astute clinician’ s "feel" for the patient.

multiple sclerosis; diagnostic criteria; history

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