Diagnosis of multiple sclerosis: progress and challenges

The diagnosis of multiple sclerosis is based on neurological symptoms and signs, alongside evidence of dissemination of CNS lesions in space and time. MRI is often sufficient to confirm the diagnosis when characteristic lesions accompany a typical clinical syndrome, but in some patients, further sup...

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Bibliographic Details
Published in:The Lancet (British edition) Vol. 389; no. 10076; pp. 1336 - 1346
Main Authors: Brownlee, Wallace J, Hardy, Todd A, Fazekas, Franz, Miller, David H
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.04.2017
Elsevier Limited
Subjects:
Age
Autoimmune diseases
Biomarkers
Brain - diagnostic imaging
Central nervous system
Cerebrospinal fluid
Demyelination
Diagnosis
Diagnosis, Differential
Diagnostic systems
Differentiation
Disorders
Encephalomyelitis
Encephalomyelitis, Acute Disseminated - diagnosis
Genetic screening
Humans
Interferon
Internal Medicine
Lesions
Magnetic Resonance Imaging
Medical diagnosis
Medical imaging
Multiple sclerosis
Multiple Sclerosis - diagnosis
Multiple Sclerosis, Relapsing-Remitting - diagnosis
Neurology
Neuromyelitis
Neuromyelitis Optica - diagnosis
Spinal cord
Spinal Cord - diagnostic imaging
Tomography
ISSN:0140-6736, 1474-547X, 1474-547X
Online Access:Get full text
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Summary:The diagnosis of multiple sclerosis is based on neurological symptoms and signs, alongside evidence of dissemination of CNS lesions in space and time. MRI is often sufficient to confirm the diagnosis when characteristic lesions accompany a typical clinical syndrome, but in some patients, further supportive information is obtained from cerebrospinal fluid examination and neurophysiological testing. Differentiation is important from other diseases in which demyelination is a feature (eg, neuromyelitis optica spectrum disorder and acute disseminated encephalomyelitis) and from non-demyelinating disorders such as chronic small vessel disease and other inflammatory, granulomatous, infective, metabolic, and genetic causes that can mimic multiple sclerosis. Advances in MRI and serological and genetic testing have greatly increased accuracy in distinguishing multiple sclerosis from these disorders, but misdiagnosis can occur. In this Series paper we explore the progress and challenges in the diagnosis of multiple sclerosis with reference to diagnostic criteria, important differential diagnoses, controversies and uncertainties, and future prospects.
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ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(16)30959-X