Inojosa Hernan, Akgün Katja, Haacke Katrin, Ziemssen Tjalf
Zentrum für klinische Neurowissenschaften, Klinik für Neurologie, Technische Universität Dresden/ Universitätsklinikum Dresden, Dresden, Deutschland.
Fortschr Neurol Psychiatr. 2021 Jul;89(7-08):374-381. doi: 10.1055/a-1397-6851. Epub 2021 Mar 15.
During the course of Multiple Sclerosis (MS), most patients with relapsing remitting MS (RRMS) convert to secondary progressive MS (SPMS), an MS-phenotype associated with a steady deterioration of functional ability independent from relapses and worsened prognosis. Due to the heterogeneity of this conversion, SPMS-diagnosis is often challenging and made retrospectively with a delay of several years. In this review, we first discuss advantages and limitations of screening tools for early SPMS-detection such as the SPMS nomogram, the MS prediction score, and the best SPMS definition approach. These screening tools might help to shorten the phase of diagnostic uncertainty. We then focus on the development of MSProDiscuss, a novel web-based tool that helps the treating neurologist to systematically assesses parameters highly relevant for SPMS-conversion during routine anamnesis. These parameters involve disease activity, symptoms, and impacts of the patient's overall symptoms. In a recent validation study, MSProDiscuss demonstrated high sensitivity, specificity, and interrater reliability. MSProDiscuss does not impose an additional time burden on the treating neurologist and its results are easy to interpret by a simple traffic light system. In first usability tests, it was therefore assessed as a helpful tool for the clinical routine. The early detection of clinically significant progression by diagnostic tools such as MSProDiscuss could open a time-window for therapeutic interventions.
在多发性硬化症(MS)病程中,大多数复发缓解型多发性硬化症(RRMS)患者会转变为继发进展型多发性硬化症(SPMS),这是一种与功能能力持续恶化相关的MS表型,与复发无关且预后较差。由于这种转变的异质性,SPMS的诊断往往具有挑战性,通常是在数年后进行回顾性诊断。在本综述中,我们首先讨论早期检测SPMS的筛查工具的优缺点,如SPMS列线图、MS预测评分和最佳SPMS定义方法。这些筛查工具可能有助于缩短诊断不确定阶段。然后,我们重点介绍MSProDiscuss的开发,这是一种新型的基于网络的工具,可帮助主治神经科医生在常规问诊期间系统地评估与SPMS转变高度相关的参数。这些参数包括疾病活动、症状以及患者整体症状的影响。在最近的一项验证研究中,MSProDiscuss显示出高敏感性、特异性和评分者间可靠性。MSProDiscuss不会给主治神经科医生带来额外的时间负担,其结果通过简单的红绿灯系统很容易解释。因此,在首次可用性测试中,它被评估为临床常规的有用工具。通过MSProDiscuss等诊断工具早期发现具有临床意义的病情进展可为治疗干预打开一个时间窗口。