A new review led by the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) provides guidance on how to diagnose suspected multiple sclerosis (MS) in individuals under 18 and adults 50 years and older.
Drafted by an international committee of 19 MS experts from North America, Europe, and Latin America, the comprehensive review published online in JAMA Neurology will help improve diagnostic accuracy in atypical presentations of the disease.
The article and its accompanying supplemental materials provide detailed figures and tables on frequently encountered MS mimics in the pediatric and late-onset populations, as well as on clinical and imaging features that are red flags and suggest an alternative diagnosis.
Key findings include:
- Pediatric MS Diagnosis:
- Children have high immunological reactivity, which manifests in how MS presents and in the increased likelihood of other mimicking disorders. There is a need to differentiate MS from other neuroimmunological conditions.
- The clinical disease course of MS is different in children compared to older adults. As childhood is a period with high inflammation, a child presenting with a progressive onset warrants further investigation for alternative diagnoses.
- While children with MS tend to have longer time to reach disability compared to adults, they are still likely to reach disability milestones at earlier ages, underscoring the need for early diagnosis to allow for timely intervention with disease-modifying therapies.
- Late-Onset MS Diagnosis:
- It is critical not to miss conditions that are more common in older populations vascular disease, spinal stenosis/compressive myelopathy and arthritis.
- Older age is a time of reduced inflammatory activity, especially in women after estrogen levels drop with menopause. Relapses triggered by inflammation happen less frequently, but disability progression tends to accelerate, raising questions about the decreasing benefits vs. increasing risk of disease-modifying therapies, which primarily target inflammation in older individuals.
- In older populations, non-specific white matter changes in the brain are more likely due to vascular disease or migraines which can lead to misdiagnosis of MS. The appearance and location of lesions detected on magnetic resonance imaging (MRI) can help differentiate white matter lesions from vascular abnormalities to improve diagnostic accuracy.
