Prior suggestive symptoms in one-third of patients consulting for a "first" demyelinating event
Prior suggestive symptoms in one-third of patients consulting for a "first" demyelinating event
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DOI：
10.1136/jnnp.2008.166421
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发表时间：
2011-03-01
影响因子：
11
通讯作者：
Allouche, S.
中科院分区：
文献类型：
--
作者：
Gout, O.;Lebrun-Frenay, C.;Allouche, S.
目的探讨多发性硬化（multiple sclerosis，MS）患者首次就诊时神经系统炎症事件的发生率，提高MS的早期诊断水平。方法首次就诊时，神经科医生向患者发放一份自填式问卷，其中包括72个关于既往症状持续时间>24 h的问题。在后续访问中，神经科医生验证的症状，并收集有关当前attack.Results的信息队列包括178例（74%的妇女，平均年龄（SD）33.7（10.1）岁）。初次就诊的主要原因是视力障碍和肢体感觉障碍。平均（SD）全球扩展残疾状态量表评分为1.4（1.1），根据BarkhofeTintore标准，46%的脑部MRI呈阳性，41%的脑脊液中有异常白色血细胞计数，71%有免疫球蛋白G寡克隆带。79例患者（44%）报告了提示脱髓鞘的既往症状，70%（55例患者）经神经科医生验证，仅4例患者经神经科医生确认。在14例具有经验证的既往症状的患者中观察到后遗症（26%）。自我管理的问卷调查显示了93%的总体敏感性和80%的特异性，用于识别患者先前的症状提示脱髓鞘。结论患者管理的问卷调查，随后由神经科医生验证表明，33%的患者咨询的第一个脱髓鞘事件有先前的症状提示中枢神经系统脱髓鞘，已经被忽视，几乎70%的患者有先前脱髓鞘的后遗症或麦克唐纳太空传播标准。这样的问卷调查可能是一个有用的工具，多发性硬化症的早期诊断。
Objective To evaluate the prevalence of prior inflammatory events in patients consulting for a first inflammatory neurological event and improve early diagnosis of multiple sclerosis.Methods During the initial visit, the neurologist gave patients a self-administered questionnaire containing 72 questions regarding previous symptoms lasting >24 h. During the follow-up visit, the neurologist validated the symptoms and collected information about the current attack.Results The cohort included 178 patients (74% women, mean age (SD) 33.7 (10.1) years). The main reason for the initial visit was visual disturbance and sensory troubles in limbs. Mean (SD) global Expanded Disability Status Scale score was 1.4 (1.1), 46% of brains MRIs were positive according to BarkhofeTintore ' criteria, 41% had abnormal white blood cell count in cerebrospinal fluid and 71% had immunoglobin G oligoclonal bands. Prior symptoms suggestive of demyelination were reported by 79 patients (44%), validated by the neurologist for 70% (55 patients) and identified only by the neurologist in four patients. Sequelae were observed in 14 patients with validated prior symptoms (26%). The self-administered questionnaire showed an overall sensitivity of 93% and specificity of 80% for identifying patients with prior symptoms suggestive of demyelination.Conclusion A patient-administered questionnaire subsequently validated by the neurologist demonstrated that 33% of patients consulting for a first demyelinating event had prior symptoms suggestive of central nervous system demyelination that had gone unnoticed, and almost 70% had either sequelae of prior demyelination or McDonald criteria for dissemination in space. Such a questionnaire could be a useful tool for earlier diagnosis of multiple sclerosis.