This Article Full Text (OnlineFirst PDF) All Versions of this Article: 1352458508096878v1 14/9/1157    most recent Alert me when this article is cited Alert me if a correction is posted 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 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. Social Bookmarking                         What's this?

Differential diagnosis of suspected multiple sclerosis: a consensus approach

¹ Department of Inflammation, Institute of Neurology, NMR Research Unit, University College London, UK
² Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
³ Neuroimaging Research Unit, Department of Neurology, Ospedale San Rafaele, Milan, Italy
⁴ The Hospital for Sick Children, Department of Paediatrics, Division of Neurology, Toronto, California, USA
⁵ The Mellen Center, Cleveland Clinic, Cleveland, Ohio, USA
⁶ MS Research Unit, Department of Medicine (Neurology), University of Ottawa, The Ottawa Hospital – General Campus, Ottawa, California, USA
⁷ Department of Neurology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
⁸ St Vincent's University Hospital, Department of Neurology, Dublin, Ireland
⁹ The Johns Hopkins Hospital, Department of Neurology, Baltimore, Maryland, USA
¹⁰ Department of Neurology, University Hospitals, Basel, Switzerland
¹¹ Department of Neurology, Kyushu University, Kyushu, Japan
¹² Corrine Goldsmith Dickinson Center for Multiple Sclerosis, Mt. Sinai School of Medicine, New York City, New York, USA
¹³ Neuroimmunology Branch, NINDS, National Institutes of Health, Bethesda, Maryland, USA
¹⁴ Unitat de Neuroimmunologia Clinica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
¹⁵ Neurology Service, University of Vermont College of Medicine, Burlington, Vermont, USA
^{16 16} Research and Clinical Programs Department, National Multiple Sclerosis Society, New York City, New York, USA
^{17 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
^{18 18} Department of Neuroinflammation, Institute of Neurology, University College London, UK

^* To whom correspondence should be addressed.

	Abstract

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

First published on September 19, 2008, doi:10.1177/1352458508096878

Multiple Sclerosis 2008;14:1157.

A more recent version of this article appeared on November 1, 2008


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				O. Garcea, A. Villa, F. Caceres, T. Adoni, M. Alegria, R. Barbosa Thomaz, R. Buzo, L. Llamas Lopez, and M. Rivera Kindel Early treatment of multiple sclerosis: a Latin American Experts Meeting Multiple Sclerosis, October 1, 2009; 15(3_suppl): S1 - S12. [Abstract] [PDF]

				M. S. Freedman 'Time is brain' also in multiple sclerosis Multiple Sclerosis, October 1, 2009; 15(10): 1133 - 1134. [PDF]

				M Khalil, C Enzinger, C Langkammer, M Tscherner, M Wallner-Blazek, M Jehna, S Ropele, S Fuchs, and F Fazekas Quantitative assessment of brain iron by R2* relaxometry in patients with clinically isolated syndrome and relapsing-remitting multiple sclerosis Multiple Sclerosis, September 1, 2009; 15(9): 1048 - 1054. [Abstract] [PDF]

				S. Glad, H. Nyland, J. Aarseth, T Riise, and K. Myhr Long-term follow-up of benign multiple sclerosis in Hordaland County, Western Norway Multiple Sclerosis, August 1, 2009; 15(8): 942 - 950. [Abstract] [PDF]

				C. Lebrun, C. Bensa, M. Debouverie, S. Wiertlevski, D. Brassat, J. de Seze, L. Rumbach, J. Pelletier, P. Labauge, B. Brochet, et al. Association Between Clinical Conversion to Multiple Sclerosis in Radiologically Isolated Syndrome and Magnetic Resonance Imaging, Cerebrospinal Fluid, and Visual Evoked Potential: Follow-up of 70 Patients Arch Neurol, July 1, 2009; 66(7): 841 - 846. [Abstract] [Full Text] [PDF]

				N Rajoriya, C J Wotton, D G R Yeates, S P L Travis, and M J Goldacre Immune-mediated and chronic inflammatory disease in people with sarcoidosis: disease associations in a large UK database Postgrad. Med. J., May 1, 2009; 85(1003): 233 - 237. [Abstract] [Full Text] [PDF]