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[多发性硬化症的诊断:2017年麦克唐纳标准修订版综述]

[Diagnosis of multiple sclerosis: A review of the 2017 revisions of the McDonald criteria].

作者信息

Csépány Tünde

机构信息

Debreceni Egyetem, Általános Orvostudományi Kar, Neurológiai Tanszék, Debrecen.

出版信息

Ideggyogy Sz. 2018 Sep 30;71(9-10):321-329. doi: 10.18071/isz.71.0321.

Abstract

The revolutionary progress of research in neuroimmu-nology has led to the introduction of disease modifying therapies in multiple sclerosis at the end of the last century. The International Panel on Diagnosis of Multiple Sclerosis originally proposed the 2001 McDonald criteria to facilitate the diagnosis of MS in patients with the first objective neurological symptom(s) suggesting demyelinating event, when magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. New terms have been introduced to substitute clinical information by MRI: dissemination in space - indicating a multifocal central demyelinating process and dissemination in time - indicating the development of new CNS lesions over time. The criteria for diagnosis of Multiple Sclerosis have continuously evolved, they were modified in 2005 and 2010 allowing for an earlier and more accurate diagnosis of MS over time, and they provided the most up-to-date guidance for clinicians and researchers. The last recommended revisions relied entirely on available evidence, and not on expert opinion thereby reducing the risk of the misdiagnosis. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical, clinically isolated syndrome. In this review, we provide an overview of the recent 2017 revisions to the criteria of dissemination in space and time with the importance of the presence of CSF-specific oligoclonal bands; keeping fully in mind that there is no better explanation for symptoms than diagnosis of MS. In the future, validation of the 2017 McDonald criteria will be needed in diverse populations. Further investigations are required on the value of new MRI approaches, on optic nerve involvement, on evoked potential and optical coherence tomography, in order to assess their possible contribution to diagnostic criteria.

摘要

神经免疫学研究的革命性进展在上世纪末促使了多发性硬化症疾病修正疗法的引入。国际多发性硬化症诊断小组最初提出了2001年麦克唐纳标准,以便在将磁共振成像与临床及其他辅助临床诊断方法相结合时,对出现提示脱髓鞘事件的首个客观神经症状的患者进行多发性硬化症的诊断。已经引入了新术语,通过磁共振成像来替代临床信息:空间扩散——表明多灶性中枢脱髓鞘过程,时间扩散——表明随着时间推移新的中枢神经系统病变的发展。多发性硬化症的诊断标准不断演变,在2005年和2010年进行了修订,随着时间的推移使得多发性硬化症能够更早、更准确地得到诊断,并且为临床医生和研究人员提供了最新的指导。最新推荐的修订完全基于现有证据,而非专家意见,从而降低了误诊风险。2017年麦克唐纳标准仍然主要适用于经历典型临床孤立综合征的患者。在本综述中,我们概述了2017年对空间和时间扩散标准的最新修订以及脑脊液特异性寡克隆带存在的重要性;要时刻牢记,对于症状而言,没有比诊断为多发性硬化症更好的解释了。未来,需要在不同人群中对2017年麦克唐纳标准进行验证。还需要进一步研究新的磁共振成像方法、视神经受累情况、诱发电位和光学相干断层扫描的价值,以评估它们对诊断标准可能做出的贡献。

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