title: Differential diagnosis of suspected multiple sclerosis: a consensus approach.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Inflammation, Institute of Neurology, NMR Research Unit, University College London, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Miller
authors.forename: B G
authors.initials: BG
authors.lastname: Weinshenker
authors.forename: M
authors.initials: M
authors.lastname: Filippi
authors.forename: B L
authors.initials: BL
authors.lastname: Banwell
authors.forename: J A
authors.initials: JA
authors.lastname: Cohen
authors.forename: M S
authors.initials: MS
authors.lastname: Freedman
authors.forename: S L
authors.initials: SL
authors.lastname: Galetta
authors.forename: M
authors.initials: M
authors.lastname: Hutchinson
authors.forename: R T
authors.initials: RT
authors.lastname: Johnson
authors.forename: L
authors.initials: L
authors.lastname: Kappos
authors.forename: J
authors.initials: J
authors.lastname: Kira
authors.forename: F D
authors.initials: FD
authors.lastname: Lublin
authors.forename: H F
authors.initials: HF
authors.lastname: McFarland
authors.forename: X
authors.initials: X
authors.lastname: Montalban
authors.forename: H
authors.initials: H
authors.lastname: Panitch
authors.forename: J R
authors.initials: JR
authors.lastname: Richert
authors.forename: S C
authors.initials: SC
authors.lastname: Reingold
authors.forename: C H
authors.initials: CH
authors.lastname: Polman
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D006801:Humans; D009103:Multiple Sclerosis / Q000175:diagnosis*; D017410:Practice Guidelines as Topic