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Differential diagnosis of suspected multiple sclerosis: a consensus approachDepartment of Inflammation, Institute of Neurology, NMR Research Unit, University College London, UK
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
Neuroimaging Research Unit, Department of Neurology, Ospedale San Rafaele, Milan, Italy
The Hospital for Sick Children, Department of Paediatrics, Division of Neurology, Toronto, California, USA
The Mellen Center, Cleveland Clinic, Cleveland, Ohio, USA
MS Research Unit, Department of Medicine (Neurology), University of Ottawa, The Ottawa Hospital – General Campus, Ottawa, California, USA
Department of Neurology, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
St Vincent’s University Hospital, Department of Neurology, Dublin, Ireland
The Johns Hopkins Hospital, Department of Neurology, Baltimore, Maryland, USA
Department of Neurology, University Hospitals, Basel, Switzerland
Department of Neurology, Kyushu University, Kyushu, Japan
Corrine Goldsmith Dickinson Center for Multiple Sclerosis, Mt. Sinai School of Medicine, New York City, New York, USA
Neuroimmunology Branch, NINDS, National Institutes of Health, Bethesda, Maryland, USA
Unitat de Neuroimmunologia Clinica, Hospital Universitari Vall d’Hebron, Barcelona, Spain
Neurology Service, University of Vermont College of Medicine, Burlington, Vermont, USA
16 Research and Clinical Programs Department, National Multiple Sclerosis Society, New York City, New York, USA
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 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
This version was published on November
1, 2008 Multiple Sclerosis, Vol. 14, No. 9,
1157-1174 (2008) This article has been cited by other articles:
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