Differential diagnosis of suspected multiple sclerosis: A consensus approach

D. H. Miller, B. G. Weinshenker, M. Filippi, B. L. Banwell, J. A. Cohen, M. S. Freedman, S. L. Galetta, M. Hutchinson, R. T. Johnson, L. Kappos, J. Kira, F. D. Lublin, H. F. McFarland, X. Montalban, H. Panitch, J. R. Richert, S. C. Reingold, Chris H. Polman

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)1157-1174
Number of pages18
JournalMultiple Sclerosis Journal
Volume14
Issue number9
DOIs
Publication statusPublished - 2008

Fingerprint

Multiple Sclerosis
Differential Diagnosis
Demyelinating Diseases
Sclerosis
Guidelines
Optic Nerve
Brain Stem
Spinal Cord
Central Nervous System

Keywords

  • Diagnosis
  • Differential diagnosis
  • Multiple sclerosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Miller, D. H., Weinshenker, B. G., Filippi, M., Banwell, B. L., Cohen, J. A., Freedman, M. S., ... Polman, C. H. (2008). Differential diagnosis of suspected multiple sclerosis: A consensus approach. Multiple Sclerosis Journal, 14(9), 1157-1174. https://doi.org/10.1177/1352458508096878

Differential diagnosis of suspected multiple sclerosis : A consensus approach. / Miller, D. H.; Weinshenker, B. G.; Filippi, M.; Banwell, B. L.; Cohen, J. A.; Freedman, M. S.; Galetta, S. L.; Hutchinson, M.; Johnson, R. T.; Kappos, L.; Kira, J.; Lublin, F. D.; McFarland, H. F.; Montalban, X.; Panitch, H.; Richert, J. R.; Reingold, S. C.; Polman, Chris H.

In: Multiple Sclerosis Journal, Vol. 14, No. 9, 2008, p. 1157-1174.

Research output: Contribution to journalArticle

Miller, DH, Weinshenker, BG, Filippi, M, Banwell, BL, Cohen, JA, Freedman, MS, Galetta, SL, Hutchinson, M, Johnson, RT, Kappos, L, Kira, J, Lublin, FD, McFarland, HF, Montalban, X, Panitch, H, Richert, JR, Reingold, SC & Polman, CH 2008, 'Differential diagnosis of suspected multiple sclerosis: A consensus approach', Multiple Sclerosis Journal, vol. 14, no. 9, pp. 1157-1174. https://doi.org/10.1177/1352458508096878
Miller, D. H. ; Weinshenker, B. G. ; Filippi, M. ; Banwell, B. L. ; Cohen, J. A. ; Freedman, M. S. ; Galetta, S. L. ; Hutchinson, M. ; Johnson, R. T. ; Kappos, L. ; Kira, J. ; Lublin, F. D. ; McFarland, H. F. ; Montalban, X. ; Panitch, H. ; Richert, J. R. ; Reingold, S. C. ; Polman, Chris H. / Differential diagnosis of suspected multiple sclerosis : A consensus approach. In: Multiple Sclerosis Journal. 2008 ; Vol. 14, No. 9. pp. 1157-1174.
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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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AU - Miller, D. H.

AU - Weinshenker, B. G.

AU - Filippi, M.

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AU - Cohen, J. A.

AU - Freedman, M. S.

AU - Galetta, S. L.

AU - Hutchinson, M.

AU - Johnson, R. T.

AU - Kappos, L.

AU - Kira, J.

AU - Lublin, F. D.

AU - McFarland, H. F.

AU - Montalban, X.

AU - Panitch, H.

AU - Richert, J. R.

AU - Reingold, S. C.

AU - Polman, Chris H.

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N2 - 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.

AB - 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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