多發性硬化症的診斷

Diagnosis of Multiple Sclerosis

楊智超(Chih-Chao Yang)

《Acta Neurologica Taiwanica》 14卷4期 (2005/12) Pp. 213-220

https://doi.org/10.29819/ANT.200512.0008

摘要

多發性硬化症(Multiple Sclerosis, MS)，是一種中樞神經系統的發炎脫髓鞘疾病，目前大部份的理論認為它是一種自體免疫疾病。此病的多樣化及複雜性對神經科醫師而言，在診斷上是一個挑戰。雖然一些典型的個案可以較確定的診斷，不過仍有許多案例著實令人困擾。目前一些免疫調控藥物的出現，加重了我們對於是否可早點診斷MS而開始治療的考慮。隨著對MS瞭解的改變及診斷工具的進步，新的診斷標準也不斷的被提出，然而診斷MS的主要標準仍是臨床的準則，也就是在基本精神上仍符合Schumacher在1965年提出的標準。Poser在1983年提出的標準，主要是加入了誘發電位及腦脊髓液的考慮。McDonald在2001年提出的標準把核磁共振的考量加入。這些診斷標準自然也會隨著時間被修改。以McDonald標準而言，它是一個較複雜的診斷率則，它比以往的標準增加了靈敏度，但也帶來些爭議。在大部分的亞洲地區多發性硬化症屬於罕見疾病，其臨床表現與西方相較亦不儘相同，是否能完全參照這些標準仍值得探討。在使用這些標準時神經科醫師也必需能正確的使用，以免造成誤判。

關鍵字

多發性硬化症 ； 診斷標準 ； Schumacher標準 ； Poser標準 ； McDonald標準

並列摘要

Multiple sclerosis (MS) is an inflammatory demyelinating autoimmune disease of the central nervous system. The disorder displays marked clinical heterogeneity. In certain cases, making diagnosis can be challenging. Diagnosis of MS has become more important in the era of treatments that change the natural history of the disease. Several general diagnostic principles are useful to guide the diagnostic approach to MS. Clinically, MS requires neurological problems associated with objective abnormalities. Certain basic principles, first outlined by Schumacher et al. (1965) are still pertinent. Poser et al. (1983) have further modified the criteria using data derived from clinical evaluation and laboratory studies, including cerebrospinal fluid analysis, evoked potentials, and imaging studies. Poser criteria have long been familial for most neurologists. The most recent addition to our diagnostic armamentarium are the McDonald criteria(2001), which are the first attempt to incorporate standardized MRI criteria into the MS diagnostic process. The most innovative use of MRI to support an MS diagnosis is dissemination of demyelination can be demonstrated by MRI alone, in the absence of any new clinical attacks. Diagnosing MS by such sensitive MRI criteria will occur more quickly than waiting for a second clinical event. This has added some sensitivity, some controversy, and a lot of confusion. The application of the new criteria on Asian MS patients remains to be validated. Each of the criteria will be discussed, with major emphasis on the McDonald criteria.

並列關鍵字

Multiple sclerosis ； Criteria ； Schumacher criteria ； Poser criteria ； McDonald criteria