Chapter 2 - Differential Diagnosis and Diagnostic Criteria for Multiple Sclerosis: Application and Pitfalls

Abstract

Publisher Summary Magnetic resonance imaging (MRI) -based diagnostic criteria represent a profound advancement as they corre­spond to the modern pathophysiological conceptualization of multiple sclerosis (MS) as a disease in which immunologic dysregulation is associated with ongoing neurodegeneration. In relapsing MS, therefore, MRI lesion burden may be a more sensitive marker of disease activity than relapse rate and allowing a definite MS diagnosis to be made earlier on the basis of MRI changes is intuitively attractive. This chapter outlines the development of the current diagnostic criteria for MS. The differentiation of MS from other central nervous system (CNS) inflammatory demyelinating conditions is also addressed. The considerations involved in developing an appropriate individualized differential diagnosis in a given patient are reviewed. The diagnosis is dependent on the demonstration of neurologic abnormalities referable to anatomically distinct regions of the CNS that develop in either a progressive or a relapsing-remitting pat­tern. The majority of patients with typical clinical and paraclinical features of MS do indeed have MS and it is inappropriate to consider this disease as a diagnosis of ex­clusion. However, it is still imperative that neurologists appreciate the limitations of the current diagnostic criteria and avoid the numerous potential pitfalls that exist. Idiopathic inflammatory demyelinating diseases (IIDD) and proposed diagnostic criteria for definite neuromyelitis optica (NMO) are tabulated.