When a patient presents with symptoms or imaging suggestive of multiple sclerosis (MS), making the correct diagnosis may at times be straightforward but in many cases is quite challenging. Symptoms may be difficult for patients to characterize and for clinicians to interpret; findings on examination may be subtle; imaging is not always specific; and the differential diagnosis of possible demyelinating disease is quite broad. Making a correct diagnosis of MS early in the disease course is likely to become even more important over time as new disease-modifying therapies, particularly those with potential neuroprotective benefits, are introduced. This article reviews the current diagnostic criteria for MS and illustrates their application as well as reviews the differential diagnosis for patients presenting with symptoms or imaging suggestive of demyelinating disease.
The diagnostic criteria for MS were revised by the International Panel on Diagnosis of Multiple Sclerosis in 2010.
The diagnostic criteria for MS have been revised several times over the years, most recently giving rise to the McDonald 2010 criteria. The diagnosis of MS begins with a patient who presents with symptoms typical for the disease, termed the “clinically isolated syndrome,” which most commonly affects the optic nerves, brainstem, or spinal cord. If the patient’s symptoms and imaging are typical for MS, the clinician can then apply the appropriate diagnostic criteria. If atypical clinical or imaging findings are present, alternative etiologies must be pursued as appropriate.
Address correspondence to Dr Ilana Katz Sand, Corinne Goldsmith Dickinson Center for MS, 5 East 98th St, Box 1138, New York, NY 10029, firstname.lastname@example.org.
Relationship Disclosure: Dr Katz Sand’s fellowship was supported in part by a Sylvia Lawry grant from the National Multiple Sclerosis Society. Dr Katz Sand has received research support from Acorda Therapeutics for an investigator-initiated study. Dr Lublin has consulting agreements with and/or serves on the advisory boards or data and safety monitoring boards of Acorda Therapeutics, Actelion Pharmaceuticals Ltd, Bayer HealthCare Pharmaceuticals, Biogen Idec, Bristol-Myers Squibb Company, Celgene Corporation, Coronado Biosciences, EMD Serono, Inc, F. Hoffman-La Roche Ltd, Genentech, Inc, Genzyme Corporation, Johnson & Johnson Services, Inc, MedImmune, LLC, Novartis Corporation, Pfizer Inc, Questcor Pharmaceuticals, Inc, Revalesio Corporation, Sanofi-Aventis, and Teva Pharmaceuticals. Dr Lublin is the co-chief editor of Multiple Sclerosis and Related Diseases, owns stock in Cognition Pharmaceuticals, Inc, and reviews medicolegal issues. Dr Lublin receives research support from Acorda Therapeutics, Biogen Idec, Celgene Corporation, Genzyme Corporation, the National Multiple Sclerosis Society, the NIH, Novartis Corporation, Sanofi-Aventis, and Teva Pharmaceuticals.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Katz Sand and Lublin report no disclosures.