Abstract
The differential diagnosis of pediatric multiple sclerosis (MS) can be broad and pose diagnostic challenges, particularly at initial presentation. Among demyelinating entities, neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibodies (MOG-ab) associated disorders, and acute disseminated encephalomyelitis (ADEM) are now well-known as unique disease processes and yet continue to overlap with MS in regards to clinical presentation and imaging. In non-inflammatory entities, such as metabolic disorders and leukodystrophies, an erroneous diagnosis of MS can be made even while applying appropriate diagnostic criteria. Knowing the epidemiology, typical clinical presentation, diagnostic criteria, and ancillary test results in each disease, can aid in making the correct diagnosis by contrasting these features with those of pediatric MS. Determining the correct diagnosis early, allows for efficient and effective treatment as well as appropriate prognostication.
Highlights
Differentiating pediatric multiple sclerosis (MS) from a wide range of disorders of both inflammatory and non-inflammatory etiologies that present in a strikingly similar way, remains a challenge in our daily clinical practice
As a starting point for each disease or disease category, we describe a clinical case seen at our own institution that delineates the challenge of differentiating these entities from pediatric MS
The international panel on NMO diagnosis (IPND) 2015 took into account the recommendations from the Pediatric Working Group members and found the new diagnostic criteria to be compatible for pediatric patients, with a few caveats: acute myelitis associated with longitudinally extensive transverse myelitis (LETM) lesion on magnetic resonance imaging (MRI) may be less specific in pediatric neuromyelitis optica spectrum disorders (NMOSD), and more children present with monophasic LETM [25]
Summary
Differentiating pediatric multiple sclerosis (MS) from a wide range of disorders of both inflammatory and non-inflammatory etiologies that present in a strikingly similar way, remains a challenge in our daily clinical practice. When a child with acute neurologic symptoms is found to have white matter abnormalities, there are a variety of factors that should be taken into consideration in the pursuit of the most likely diagnosis. These include epidemiologic data, presenting signs and symptoms, diagnostic criteria, and ancillary tests. Our review focuses on differential diagnoses that are commonly mistaken for MS, as we attempt to compile what the most recent literature defines in terms of epidemiology/pathophysiology, clinical presentation, diagnosis, and treatment/prognosis for each. As a starting point for each disease or disease category, we describe a clinical case seen at our own institution that delineates the challenge of differentiating these entities from pediatric MS
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