Gafson Arie, Giovannoni Gavin, Hawkes Christopher H
University College London Medical School, Gower Street, London WC1E 6BT2, UK.
Neuroscience Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK.
Mult Scler Relat Disord. 2012 Jan;1(1):9-14. doi: 10.1016/j.msard.2011.08.002. Epub 2011 Sep 9.
The history of diagnostic criteria for multiple sclerosis (MS) from Charcot to McDonald is reviewed. Although the criteria have evolved positively with each revision we think there is still room for improvement. It is proposed that the 2010 revision to the McDonald criteria should be used for research or drug trials and comprise two categories: 'MS' and 'Not MS'. McDonald 2010 could be used optionally for routine clinical purposes. The categories 'probable' and 'possible' are permissible for everyday clinical activity, particularly where there is limited access to MRI, but they would not be appropriate for research or drug trials. Future updates should make it mandatory to perform MRI of the brain, and possibly spinal cord, and the definition of 'an attack' should be revised to include information from physical examination or MRI. Finally, we suggest that certain paroxysmal symptoms (e.g. Lhermitte phenomenon) should be incorporated in any further revision.
回顾了从夏科（Charcot）到麦克唐纳（McDonald）多发性硬化症（MS）诊断标准的历史。尽管每次修订标准都有积极进展，但我们认为仍有改进空间。建议将2010年修订的麦克唐纳标准用于研究或药物试验，该标准分为两类：“MS”和“非MS”。2010年麦克唐纳标准可选择性地用于常规临床目的。“可能”和“疑似”类别在日常临床活动中是允许的，特别是在MRI检查受限的情况下，但它们不适用于研究或药物试验。未来更新应强制要求进行脑部甚至可能包括脊髓的MRI检查，并且“发作”的定义应修订以纳入体格检查或MRI的信息。最后，我们建议在进一步修订中应纳入某些发作性症状（如莱尔米特现象）。
