Solomon Andrew J, Arrambide Georgina, Brownlee Wallace, Cross Anne H, Gaitan María I, Lublin Fred D, Makhani Naila, Mowry Ellen M, Reich Daniel S, Rovira Àlex, Weinshenker Brian G, Cohen Jeffrey A
Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH.
Neurol Clin Pract. 2022 Jun;12(3):263-269. doi: 10.1212/CPJ.0000000000001149.
Patients with a historical diagnosis of multiple sclerosis (MS)-a patient presenting with a diagnosis of MS made previously and by a different clinician-present specific diagnostic and therapeutic challenges in clinical practice. Application of the McDonald criteria is most straightforward when applied contemporaneously with a syndrome typical of an MS attack or relapse; however, retrospective application of the criteria in some patients with a historical diagnosis of MS can be problematic. Limited patient recollection of symptoms and evolution of neurologic examination and MRI findings complicate confirmation of an earlier MS diagnosis and assessment of subsequent disease activity or clinical progression. Adequate records for review of prior clinical examinations, laboratory results, and/or MRI scans obtained at the time of diagnosis or during ensuing care may be inadequate or unavailable. This article provides recommendations for a clinical approach to the evaluation of patients with a historical diagnosis of MS to aid diagnostic confirmation, avoid misdiagnosis, and inform therapeutic decision making.
有多发性硬化症（MS）既往诊断的患者——即之前由不同临床医生诊断为MS的患者——在临床实践中呈现出特定的诊断和治疗挑战。当与典型的MS发作或复发综合征同时应用时，麦克唐纳标准的应用最为直接；然而，在一些有MS既往诊断的患者中回顾性应用该标准可能会有问题。患者对症状的回忆有限，以及神经学检查和MRI结果的演变，使得早期MS诊断的确认以及后续疾病活动或临床进展的评估变得复杂。用于回顾诊断时或后续治疗期间获得的既往临床检查、实验室结果和/或MRI扫描的充分记录可能不充分或无法获得。本文提供了对有MS既往诊断患者进行评估的临床方法建议，以帮助确诊、避免误诊并为治疗决策提供依据。
