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Diagnose der Multiplen Sklerose: Revision der McDonald-Kriterien 2017

verfasst von: O. Aktas, M. P. Wattjes, M. Stangel, H.-P. Hartung

Erschienen in: Der Nervenarzt | Ausgabe 12/2018

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Zusammenfassung

Die Diagnose der Multiplen Sklerose (MS) stützt sich auf zwei Pfeiler: 1) den Nachweis einer örtlichen und zeitlichen Dissemination der fokal-neurologischen Defizite, 2) den Ausschluss wichtiger Differenzialdiagnosen. Auch die aktuelle Revision der Diagnosekriterien – McDonald 2017 – folgt diesen Prinzipien, berücksichtigt neue Daten zur MRT-Bildgebung und stärkt die (zuletzt eingeschränkte) Rolle der Liquordiagnostik bei der schubförmigen Verlaufsform. Übergeordnetes Ziel bleibt die möglichst frühe zuverlässige Diagnosestellung zwecks zeitnahem Start einer verlaufsmodifizierenden Therapie. Zu den konkreten Neuerungen gehören die Berücksichtigung kortikaler MRT-Läsionen (äquivalent zu juxtakortikalen Herden), die aufgehobene Differenzierung zwischen asymptomatischen und symptomatischen MRT-Läsionen und die Berücksichtigung charakteristischer Liquorbefunde für das Kriterium der zeitlichen Dissemination. So lässt sich bereits bei einem ersten Schub mit der Detektion liquorspezifischer oligoklonaler Bande sowie dem MRT-Nachweis einer MS-typischen örtlichen Läsionsverteilung (auch ohne Schrankenstörung) eine MS diagnostizieren. Für die primär-progrediente Verlaufsform, für die mittlerweile auch eine erste Therapieoption existiert, bleibt die bekannte Definition bestehen. Hinsichtlich der Differenzialdiagnostik erfolgt eine klare Abgrenzung gegenüber den mittlerweile als NMO-Spektrum-Erkrankungen (NMOSD) bezeichneten, meist durch Anti-Aquaporin-4-Antikörper charakterisierten Devic-Syndrom. Die Zuordnung des sog. radiologisch isolierten Syndroms (RIS, inzidentell gefundene MS-typische MRT-Läsionen ohne klinisches Korrelat), der Stellenwert von Erkrankungen mit Nachweis von Myelin-Oligodendrozyten-Glykoprotein(MOG)-Antikörpern wie auch eine einheitliche Definition für den sekundär chronisch-progredienten Verlauf bleiben offen. Zusammengefasst steht damit McDonald 2017 im konzeptuellen Gerüst der Vorgänger und vereinfacht die Frühdiagnose.

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Titel: Diagnose der Multiplen Sklerose: Revision der McDonald-Kriterien 2017
verfasst von: O. Aktas
M. P. Wattjes
M. Stangel
H.-P. Hartung
Publikationsdatum: 06.06.2018
Verlag: Springer Medizin
Schlagwörter: Magnetresonanztomografie
Magnetresonanztomografie
Multiple Sklerose
Neuromyelitis-optica-Spektrum-Erkrankung
Erschienen in: Der Nervenarzt / Ausgabe 12/2018
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI: https://doi.org/10.1007/s00115-018-0550-0

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