Unitat de Neuroimmunologia Clínica, Multiple Sclerosis Center of Catalonia (CEMCat) and Unitat de Ressonància Magnètica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Mult Scler. 2009 Dec;15(12):1459-65. doi: 10.1177/1352458509348422. Epub 2009 Dec 7.
The diagnostic criteria used in primary progressive (PP) and relapsing-remitting (RR) multiple sclerosis (MS) show substantial differences. This introduces complexity in the diagnosis of MS which could be resolved if these criteria could be unified in terms of the requirements for dissemination in space (DIS). The aim of this study was to assess whether a single algorithm may be used to demonstrate DIS in all forms of MS. Five sets of RRMS criteria for DIS were applied to a cohort of 145 patients with established PPMS (mean disease duration: 11 years - PPMS-1): C1: Barkhof-Tintoré (as in 2005 McDonald's criteria); C2: Swanton et al. (as in JNNP 2006); C3: presence of oligoclonal bands plus two lesions (as in McDonald's criteria); C4 and C5: a two-step approach was also followed (patients not fulfilling C1 or C2 were then assessed for C3). Two sets of PPMS criteria for DIS were applied: C6: Thompson et al. (as in 2001 McDonald's criteria); C7: 2005 McDonald criteria. A second sample of 55 patients with less than 5 years of disease duration (PPMS-2) was also analysed using an identical approach. For PPMS-1/PPMS-2, fulfilment was: C1:73.8%/66.7%; C2:72.1%/59.3%; C3:89%/79.2%; C4:96%/92.3%; C5:96%/85.7%; C6:85.8%/78.7%; C7:91%/80.4%. Levels of fulfilment suggest that the use of a single set of criteria for DIS in RRMS and PPMS might be feasible, and reinforce the added value of cerebrospinal fluid (CSF) findings to increase fulfilment in PPMS. Unification of the DIS criteria for both RRMS and PPMS could be considered in further revisions of the MS diagnostic criteria.
原发性进展型（PP）和复发缓解型（RR）多发性硬化症（MS）的诊断标准存在显著差异。这给 MS 的诊断带来了复杂性，如果这些标准在空间传播要求（DIS）方面能够统一，那么这种复杂性就可以得到解决。本研究旨在评估是否可以使用单一算法来证明所有 MS 形式的 DIS。将五套 RRMS 的 DIS 标准应用于一组 145 例确诊的原发性进展型多发性硬化症（PPMS）患者（平均病程：11 年-PPMS-1）：C1：Barkhof-Tintoré（如 2005 年 McDonald 标准）；C2：Swanton 等人（如 2006 年 JNNP）；C3：寡克隆带阳性加两个病灶（如 McDonald 标准）；C4 和 C5：还采用了两步法（不符合 C1 或 C2 的患者随后评估 C3）。将两套 PPMS 的 DIS 标准应用于两组患者：C6：Thompson 等人（如 2001 年 McDonald 标准）；C7：2005 年 McDonald 标准。还对另外 55 例病程不足 5 年的患者（PPMS-2）进行了相同的分析。对于 PPMS-1/PPMS-2，符合标准的比例分别为：C1：73.8%/66.7%；C2：72.1%/59.3%；C3：89%/79.2%；C4：96%/92.3%；C5：96%/85.7%；C6：85.8%/78.7%；C7：91%/80.4%。符合率表明，RRMS 和 PPMS 中使用单一 DIS 标准集可能是可行的，并加强了脑脊液（CSF）发现对增加 PPMS 符合率的价值。在 MS 诊断标准的进一步修订中，可以考虑统一 RRMS 和 PPMS 的 DIS 标准。
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