Guidelines for differential diagnosis of suspected multiple sclerosis

This article comments on guidelines published by the International Advisory Committee on Clinical Trials in MS in relation to exclusion of alternative diagnoses when multiple sclerosis (MS) is suspected. The guidelines cover recommendations from three working groups, each with a different remit: identification of 'red flags' for alternative diagnoses to MS; design of diagnostic algorithms for common clinically isolated syndromes; and differentiation of MS from other idiopathic inflammatory demyelinating diseases. The major red flags identified in the study provide a useful list of diseases that need to be considered in the differential diagnosis of MS. The definition of clinically isolated syndromes is broadened, and the panel suggests that a stricter definition of encephalopathy should be set for acute disseminated encephalomyelitis. The guidelines demonstrate the potential complexity of MS diagnosis--especially during the early stages of disease--and give useful guidance, especially for the non-MS neurologist, as to how to approach the diagnosis in a systematic way.