Confavreux C, Vukusic S, Achiti J
Centre de Coordination Européen EDMUS (European Database for MUltiple Sclerosis) sur la Sclérose en Plaques, Service de Neurologie A, Hôpital Neurologique, 59, bd Pinel, 69003 Lyon, France.
Rev Neurol (Paris). 2001 Sep;157(8-9 Pt 2):907-13.
Multiple sclerosis (MS) is a disease of unknown origin and for which there is no specific diagnostic test. The diagnosis of MS is always the result of a more or less simple procedure, depending on the cases, and it remains uncertain until evidence of anatomo-pathological signs have been brought forward. An almost unanimous consensus does exist regarding several points. In the presence of suggestive or, at least, compatible neurological signs and in the absence of any alternative diagnosis according to a neurologist expert in MS, the diagnosis of MS is based on three criteria: the evidence of at least two different lesions in the white matter of the central nervous system, which is called the "space dissemination" criterion; the evidence of at least two different episodes in the disease course, which is called "time dissemination"; the evidence of a chronic inflammation of the central nervous system revealed through the analysis of the cerebrospinal fluid, i.e. the "infammatory" criterion. The observation of one or several of these criteria allows to establish the diagnosis of MS with more or less certainly, likely to be reassessed according to the subsequent course of the disease. There is a wide consensus today with Poser's classification (Poser et al., 1983) which combines the three criteria and distinguishes five different categories. According to Poser et al., space dissemination may be proved on clinical examination, but also with the brain MRI and, failing that, with the evoked potentials. Time dissemination is based only on clinical signs and the inflammatory criterion is as significant as the two other criteria. This classification has just been revised by an expert committee (McDonald et al., 2001) who wish to simplify it into two different categories (MS vs possible MS). It has been suggested that time dissemination should be proven by the observation of MRI signs three months at least after the previous clinical episode or the previous MRI. It has been suggested also to use the inflammatory criterion in second position in replacement of the space criterion when the latter is missing on the clinical and paraclinical levels. Time will say whether this new classification will replace the previous one.
多发性硬化症（MS）是一种病因不明的疾病，且尚无特异性诊断测试。MS的诊断总是或多或少取决于具体病例的简单程序的结果，在提出解剖病理学体征的证据之前，诊断一直不确定。关于几个要点确实存在几乎一致的共识。在存在提示性或至少相符的神经学体征且根据MS专家神经科医生没有其他替代诊断的情况下，MS的诊断基于三个标准：中枢神经系统白质中至少两个不同病变的证据，这称为“空间扩散”标准；病程中至少两个不同发作的证据，这称为“时间扩散”；通过脑脊液分析揭示的中枢神经系统慢性炎症的证据，即“炎症”标准。观察到这些标准中的一个或几个可以或多或少确定地确立MS的诊断，可能会根据疾病的后续病程重新评估。如今，对于波泽分类法（波泽等人，1983年）存在广泛共识，该分类法结合了这三个标准并区分了五个不同类别。根据波泽等人的说法，空间扩散可以通过临床检查证明，也可以通过脑部MRI证明，如果不行，则通过诱发电位证明。时间扩散仅基于临床体征，炎症标准与其他两个标准同样重要。一个专家委员会（麦克唐纳等人，2001年）刚刚对该分类法进行了修订，他们希望将其简化为两个不同类别（MS与可能的MS）。有人建议，时间扩散应通过在前一次临床发作或前一次MRI至少三个月后观察MRI体征来证明。还建议在临床和辅助检查层面缺少空间标准时，将炎症标准置于第二位以替代空间标准。时间会证明这种新分类法是否会取代以前的分类法。
