Differential diagnosis of suspected multiple sclerosis: a consensus approach

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.

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Affiliated Institutions

• Cleveland Clinic US
• Kyushu University JP
• University College Dublin IE
• Hospital of the University of Pennsylvania US
• Mayo Clinic US
• St. Vincent's University Hospital IE
• Pennsylvania Hospital US
• University Hospital of Basel CH
• Johns Hopkins Hospital US
• Ottawa University US
• University College London GB
• National Multiple Sclerosis Society US
• Vall d'Hebron Hospital Universitari ES
• Vrije Universiteit Amsterdam NL
• National Institute of Neurological Disorders and Stroke US
• University of Vermont US
• National Institutes of Health US

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