An international consortium led by the
Americas Committee for Treatment and Research in MS (ACTRIMS) has published detailed updated recommendations for how to distinguish suspected multiple sclerosis from other look-alike disorders. This critical guidance aims to reduce the time spent to confirm an accurate diagnosis of MS.
Background: While diagnostic criteria exist to help make an accurate diagnosis of MS, it sometimes is not an easy disease to diagnose. Clinical, laboratory, and imaging findings similar to those of MS can be caused by other conditions. It is crucial that clinicians rule out other possible explanations before telling a person that they have MS. The process of ruling out other conditions, also called “differential diagnosis,” has been part of the MS diagnosis process for many years. Recommendations for approaches to MS differential diagnosis were previously addressed in detail in 2008 by a panel convened by the
International Advisory Committee on Clinical Trials in MS (a group jointly sponsored by the National MS Society and the European Committee for Treatment and Research in MS).
Now that much more is known about MS and the disorders that are most often mistaken for it, ACTRIMS established the MS Differential Diagnosis Consortium to bring together experts in MS from around the globe to update guidance around this process. The
Consortium of MS Centers, the
European Committee for Treatment and Research in MS, the International Advisory Committee on Clinical Trials in MS, and the
MS International Federation also played a key role in recommending this update.
The Paper: To complete this effort, the Consortium reviewed 476 relevant studies published after 2008 and developed detailed recommendations and tools for how healthcare providers can distinguish MS from many other disorders. These recommendations are reported in a paper published online in
Lancet Neurology on July 19, 2023. Clinicians can learn what to look for in terms of symptoms, physical examination, laboratory tests, and imaging to identify diagnoses that may mimic MS. Flow charts are provided to guide clinicians through the process of how to rule out each of these conditions before diagnosing MS. The paper also provides new guidance for how to consider race, ethnicity and genetic ancestry in the differential diagnosis of MS.
Why does this matter? Despite the existence of well-developed diagnostic criteria, MS remains a challenging disease to diagnose because of many look-alike disorders. This paper provides important guidance that can help clinicians rule out other disorders before an MS diagnosis is considered definite. Ultimately, having biomarkers (such as a blood test) that can better distinguish MS from other disorders would be ideal for speeding up diagnosis, and treating MS as early as possible, to help stop MS in its tracks. Investigators around the world are working to find these biomarkers.
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“Differential diagnosis of suspected multiple sclerosis: an updated consensus approach” by Andrew J Solomon, Georgina Arrambide, Wallace J Brownlee, Eoin P Flanagan, Maria Pia Amato, Lilyana Amezcua, Brenda L Banwell, Frederik Barkhof, John R Corboy, Jorge Correale, Kazuo Fujihara, Jennifer Graves, Mary Pat Harnegie, Bernhard Hemmer, Jeannette Lechner-Scott, Ruth Ann Marrie, Scott D Newsome, Maria A Rocca, Walter Royal III, Emmanuelle L Waubant, Bassem Yamout, and Jeffrey A Cohen is published in
Lancet Neurology (published online July 19, 2023). This paper is available free of charge with registration on the journal website.