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Differential diagnosis of suspected multiple sclerosis: a consensus approach

Department of Inflammation, Institute of Neurology, NMR Research Unit, University College London, UK

BG Weinshenker

Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

M Filippi

Neuroimaging Research Unit, Department of Neurology, Ospedale San Rafaele, Milan, Italy

BL Banwell

The Hospital for Sick Children, Department of Paediatrics, Division of Neurology, Toronto, California, USA

JA Cohen

The Mellen Center, Cleveland Clinic, Cleveland, Ohio, USA

MS Freedman

MS Research Unit, Department of Medicine (Neurology), University of Ottawa, The Ottawa Hospital – General Campus, Ottawa, California, USA

SL Galetta

Department of Neurology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA

M Hutchinson

St Vincent’s University Hospital, Department of Neurology, Dublin, Ireland

RT Johnson

The Johns Hopkins Hospital, Department of Neurology, Baltimore, Maryland, USA

L Kappos

Department of Neurology, University Hospitals, Basel, Switzerland

J Kira

Department of Neurology, Kyushu University, Kyushu, Japan

FD Lublin

Corrine Goldsmith Dickinson Center for Multiple Sclerosis, Mt. Sinai School of Medicine, New York City, New York, USA

HF McFarland

Neuroimmunology Branch, NINDS, National Institutes of Health, Bethesda, Maryland, USA

X Montalban

Unitat de Neuroimmunologia Clinica, Hospital Universitari Vall d’Hebron, Barcelona, Spain

H Panitch

Neurology Service, University of Vermont College of Medicine, Burlington, Vermont, USA

JR Richert

16 Research and Clinical Programs Department, National Multiple Sclerosis Society, New York City, New York, USA

SC Reingold

16 Research and Clinical Programs Department, National Multiple Sclerosis Society, New York City, New York, USA; 17 Scientific and Clinical Review Associates, LLC, New York City, New York, USA

CH Polman

18 Department of Neuroinflammation, Institute of Neurology, University College London, UK ch.polman{at}vumc.nl

Background and objectives

Diagnosis of multiple sclerosis (MS) requires exclusion of diseases that could better explain the clinical and paraclinical findings. A systematic process for exclusion of alternative diagnoses has not been defined. An International Panel of MS experts developed consensus perspectives on MS differential diagnosis.

Methods

Using available literature and consensus, we developed guidelines for MS differential diagnosis, focusing on exclusion of potential MS mimics, diagnosis of common initial isolated clinical syndromes, and differentiating between MS and non-MS idiopathic inflammatory demyelinating diseases.

Results

We present recommendations for 1) clinical and paraclinical red flags suggesting alternative diagnoses to MS; 2) more precise definition of "clinically isolated syndromes" (CIS), often the first presentations of MS or its alternatives; 3) algorithms for diagnosis of three common CISs related to MS in the optic nerves, brainstem, and spinal cord; and 4) a classification scheme and diagnosis criteria for idiopathic inflammatory demyelinating disorders of the central nervous system.

Conclusions

Differential diagnosis leading to MS or alternatives is complex and a strong evidence base is lacking. Consensus-determined guidelines provide a practical path for diagnosis and will be useful for the non-MS specialist neurologist. Recommendations are made for future research to validate and support these guidelines. Guidance on the differential diagnosis process when MS is under consideration will enhance diagnostic accuracy and precision.

Key Words: diagnosis • differential diagnosis • multiple sclerosis

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This version was published on November 1, 2008

Multiple Sclerosis, Vol. 14, No. 9, 1157-1174 (2008)
DOI: 10.1177/1352458508096878


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This Article Immediate free access via SAGE Open OA Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Miller, D. Articles by Polman, C. Search for Related Content PubMed PubMed Citation Articles by Miller, D. Articles by Polman, C. Pubmed/NCBI databases Medline Plus Health Information Multiple Sclerosis Social Bookmarking                         What's this?