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donderdag 11 januari 2018

The Lancet: [Position Paper] Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria

[Position Paper] Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
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.
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[Comment] Refining the use of MRI to predict multiple sclerosis
The field of multiple sclerosis has undergone astounding changes over the past three decades. Many developments are the result of MRI, which has improved multiple sclerosis diagnosis and enhanced clinical trial outcome measures. The term clinically isolated syndrome describes a first symptomatic episode of CNS demyelination that might later develop into multiple sclerosis. Improving the imaging criteria to predict conversion to clinically definite multiple sclerosis has been a major, collaborative research effort.
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[In Context] What do our brains really want?
Animal behaviour is complex, and the understanding of human behaviour is no exception. An individual's previous experiences can influence everyday routine decision making processes, which in turn can affect habits and behaviours. But what happens when individuals are presented with new scenarios and choices? In these situations, the brain has to anticipate the right action to reach the desired outcome.
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[Comment] CT scanning to diagnose CAA: back to the future?
Most intracerebral haemorrhages are due to cerebral small vessel diseases hypertensive arteriopathy (arteriolosclerosis), which affects deep perforating vessels, and cerebral amyloid angiopathy (CAA), which affects superficial cortical and leptomeningeal vessels. Diagnosis of CAA is important because it has a high recurrence risk (7·4% per year in a pooled analysis of cohort studies)1 and might require specific prevention strategies (eg, modifying the use of antithrombotic drugs) or, in the future, disease-modifying treatments targeting vascular β-amyloid.
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[Articles] The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study
The CT and APOE genotype prediction model for CAA-associated lobar intracerebral haemorrhage shows excellent discrimination in this cohort, but requires external validation. The Edinburgh rule-in and rule-out diagnostic criteria might inform prognostic and therapeutic decisions that depend on identification of CAA-associated lobar intracerebral haemorrhage.
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