Navigating the challenges of diagnosing multiple sclerosis

Geographic and ethnic considerations in the differential diagnosis of multiple sclerosis, which are highlighted in the Personal View, are crucial given the increasing recognition of multiple sclerosis worldwide.6 MRI scans depicting common alternative diagnoses would have additionally been useful, and sensitivities and specificities of various tests for differential evaluation, which are not included in the Personal View, would further inform and advance the field. Other challenges highlighted in the Personal View include heterogeneous presentation, as well as the absence of a specific diagnostic biomarker for multiple sclerosis, unlike myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and AQP4-antibody-positive neuromyelitis optica spectrum disorder; these disorders are closely related to multiple sclerosis but are more directly identified and diagnosed on the basis of disease-specific antibodies that reflect the underlying disease biology, when present in addition to appropriate clinical and radiological features.7,8 Moreover, the length of the Personal View reflects the complexity of diagnosing multiple sclerosis and the requirement for more specific and sensitive diagnostic tests. Prevalence among people with multiple sclerosis Differential diagnoses 50 years 5–10% of cases5 Stroke, vasculitis, neurodegenerative diseases, cerebral amyloid angiopathy, and lymphoma Table Common multiple sclerosis differential diagnoses by age group