Queen Mary University of London, Neuroscience & Trauma Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK.
Mult Scler. 2010 May;16(5):566-75. doi: 10.1177/1352458510362441. Epub 2010 Mar 1.
The McDonald Criteria for Multiple Sclerosis in general have replaced the Poser criteria. Despite this, many consider that there are still areas of ambiguity. In this study, neurologists completed a questionnaire about familiarity with, usefulness and applicability of the McDonald Criteria for Multiple Sclerosis. Understanding of 'attack'; objective clinical evidence; 'two or more lesions' and their ability to interpret case scenarios was evaluated. Responses were analysed overall and by skill group. Ninety-seven consultants and 30 trainees responded, of whom 37 operated a multiple sclerosis clinic ('experts'). Some (62%) thought the McDonald Criteria for Multiple Sclerosis were useful, and 31% found them confusing or difficult to apply; 38% thought the criteria should be applied universally, others (14-28%) favoured their use for drug trials/research, and 17% rarely used them. Thirty-six (29.1%) thought the McDonald Criteria for Multiple Sclerosis specified two categories: 'MS and not MS', but others considered 'possible' or 'probable' multiple sclerosis were permitted. Experts understood better 'an attack' and 'objective clinical evidence'. All skill groups comprehended poorly what constituted an episode of demyelination, and whether Lhermitte's phenomenon was acceptable as evidence for cervical cord demyelination. A consistent response was given by 44-50% to 'two or more lesions', although this is not well defined. Criteria for primary progressive multiple sclerosis were understood well. We conclude that the McDonald Criteria for Multiple Sclerosis have improved diagnosis but areas of misinterpretation remain, particularly the definition of 'an attack', 'objective clinical evidence' and 'two or more lesions'. There was uncertainty about how many multiple sclerosis categories were permitted and whether the terms 'possible' and 'probable' were allowable. Further clarification might allow the criteria to be applied more consistently.
麦当劳多发性硬化症标准已普遍取代了波塞标准。尽管如此，许多人仍认为仍存在模糊之处。在这项研究中，神经科医生完成了一份有关他们对多发性硬化症麦当劳标准的熟悉程度、有用性和适用性的问卷。评估了他们对“发作”、客观临床证据、“两个或多个病灶”以及他们解释病例场景的能力的理解。对总体和按技能组的回答进行了分析。97 名顾问和 30 名学员做出了回应，其中 37 人经营多发性硬化症诊所（“专家”）。一些人（62%）认为多发性硬化症麦当劳标准有用，而 31%的人认为这些标准令人困惑或难以应用；38%的人认为应该普遍应用这些标准，其他人（14-28%）赞成将其用于药物试验/研究，而 17%的人很少使用这些标准。36 人（29.1%）认为多发性硬化症麦当劳标准指定了两类：“多发性硬化症和非多发性硬化症”，但其他人认为允许“可能”或“可能”的多发性硬化症。专家更好地理解了“发作”和“客观临床证据”。所有技能组都对脱髓鞘的发作构成以及是否可以接受莱尔米特现象作为颈髓脱髓鞘的证据理解较差。对于“两个或多个病灶”，44-50%的人给出了一致的回答，尽管这没有明确定义。原发性进行性多发性硬化症的标准得到了很好的理解。我们得出结论，麦当劳多发性硬化症标准改善了诊断，但仍存在误解，特别是“发作”、“客观临床证据”和“两个或多个病灶”的定义。对于允许的多发性硬化症类别数量以及是否允许使用“可能”和“可能”的术语存在不确定性。进一步澄清可能会使标准得到更一致的应用。
