Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
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DOI：
10.1016/s1474-4422(17)30470-2
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发表时间：
2018-02-01
期刊：
影响因子：
48
通讯作者：
Cohen, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Thompson, Alan J.;Banwell, Brenda L.;Cohen, Jeffrey A.
2010年麦克唐纳诊断多发性硬化症的标准被广泛应用于研究和临床实践。过去7年的科学进步表明，它们可能不再为临床医生和研究人员提供最新的指导。国际多发性硬化症诊断小组审查了2010年的麦克唐纳标准并建议进行修订。2017年的麦克唐纳标准继续主要适用于经历典型临床隔离综合征的患者，定义了需要什么才能实现中枢神经系统病变在时间和空间上的传播，并强调没有必要对这种表现做出更好的解释。进行了以下改变：在典型的临床孤立综合征和临床或MRI表现为空间播散的患者中，脑脊液特异性寡克隆条带的存在可以诊断多发性硬化症；症状性病变可以用来显示幕上、幕下或脊髓综合征患者的空间或时间播散；皮质病变可以用来显示空间播散。进一步完善标准的研究应侧重于视神经受累、在不同人群中的验证，以及结合先进的成像、神经生理和体液标志物。
The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS,and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.