Differential diagnosis of suspected multiple sclerosis: an updated consensus approach

CD22 blockade aggravates EAE and its role in microglia polarization

“…Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS), 1 , 2 and experimental autoimmune encephalomyelitis (EAE) mimics the typical pathologies of MS including inflammation and demyelinating and glial hyperplasia, and induces typical behavioral manifestations. 3 , 4 …”

Multiple sclerosis can be diagnosed solely with dissemination in space: No

“…5 Notably, DIT by gadolinium-enhancing lesions was important in predicting MS diagnosis in patients with RIS (odds ratio (OR) = 1.8). 5 In clinical practice, detection of enhancing lesions aids the differentiation of DIS-fulfilling common MS mimics—such as migraine or small vessel ischemic disease—from RIS or MS. 6,7…”

“…Arguably, many MS-mimicking syndromes are not excluded by fulfillment of both DIS and DIT, and atypical findings suggesting alternative disorders 7 must be dexterously identified by the astute neurologist—underscored by the catchall requirement in the Schumacher criteria that “the patient’s signs and symptoms cannot be explained better by some other disease process.” 1 This necessary but undesirable caveat persists in MS diagnostic criteria, highlighting the unmet need for biomarkers with high specificity for MS that may fulfill the role of DIT whether or not they provide actual DIT.…”

Commentary: Solomon AJ et al. Differential diagnosis of suspected multiple sclerosis: An updated consensus approach. Lancet Neurol 2023; 22(8): 750–768

“…Since the publication of the Miller et al paper, there has been considerable expansion in knowledge regarding disorders in the differential diagnosis of MS. A recent paper from Solomon et al 3 provides an update on the evaluation of suspected MS. The paper was prepared by members of the Multiple Sclerosis Differential Diagnosis Consortium organized by Americas Committee for Treatment and Research in MS in collaboration with the International Advisory Committee on Clinical Trials in MS, European Committee for Treatment and Research in MS, Consortium of MS Centers, and MS International Federation.…”

“…5 This change potentially might further increase the risk of misdiagnosis. It is anticipated that the comprehensive approach to differential diagnosis presented in the paper by Solomon et al 3 will be a useful resource, especially with potential future modifications of the McDonald Criteria.…”