McHugh J C, Galvin P L, Murphy R P
Department of Neurology, AMNCH, Tallaght, Dublin 24, Ireland.
Mult Scler. 2008 Jan;14(1):81-5. doi: 10.1177/1352458507081169. Epub 2007 Oct 17.
The McDonald criteria were introduced in 2001 as guidelines to facilitate early and accurate diagnosis of multiple sclerosis (MS). They were revised in 2005. Although validated in a number of research-focused clinical centres, their adequacy and utility in the general neurology setting is less certain.
In this study, we assessed new diagnoses of MS in our practice for compliance with both the original and the revised criteria.
We retrospectively identified new diagnoses of MS from 2001. Clinical notes and imaging were evaluated for compliance with McDonald criteria.
Sixty-two patients were included: 53 with ;practice-definite' and nine with ;practice-possible' diagnoses of MS. At the time of diagnosis, 47% of the ;practice-definite' group fulfilled the 2001 criteria and 49% the revised criteria. Among patients not satisfying the criteria at time of diagnosis, 21% went on to fulfil the McDonald criteria over the 23-month follow-up.
There is a considerable gap between the clinical diagnosis of MS in a general neurology setting and compliance with the McDonald criteria. Failure to perform follow-up MRI on patients with clinically isolated syndromes is a sizeable factor in this diagnostic-gap and needs to be improved. In this setting, practical differences between the original and revised criteria appear to be small.
2001年引入了麦克唐纳标准作为促进多发性硬化症（MS）早期准确诊断的指南。这些标准在2005年进行了修订。尽管在一些以研究为重点的临床中心得到了验证，但其在普通神经科环境中的充分性和实用性尚不确定。
在本研究中，我们评估了我们诊所中MS的新诊断病例是否符合原始标准和修订后的标准。
我们回顾性地确定了2001年以来MS的新诊断病例。对临床记录和影像学检查进行评估，以确定是否符合麦克唐纳标准。
共纳入62例患者：53例为“临床确诊”，9例为“临床疑似”MS诊断。在诊断时，“临床确诊”组中47%的患者符合2001年标准，49%符合修订后的标准。在诊断时未满足标准的患者中，21%在23个月的随访中最终符合了麦克唐纳标准。
在普通神经科环境中MS的临床诊断与符合麦克唐纳标准之间存在相当大的差距。对临床孤立综合征患者未进行随访MRI检查是造成这一诊断差距的一个重要因素，需要加以改进。在这种情况下，原始标准和修订后标准之间的实际差异似乎很小。
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