Commentary
Video
Updates on Guidance for Diagnosing Pediatric and Late-Onset Multiple Sclerosis: Andrew Solomon, MD
Author(s):
The professor of neurological sciences at the University of Vermont discussed the work of the MS Differential Diagnosis Consortium, highlighting efforts to refine MS differential diagnosis and improve clinical accuracy. [WATCH TIME: 8 minutes]
WATCH TIME: 8 minutes
“The diagnostic process [for multiple sclerosis] should be thinking about our diagnostic criteria and making sure that patients fulfill that criteria but also considering other diagnoses that can mimic [the disease] along the way.”
The MS Differential Diagnosis Consortium (MSDDC), sponsored by the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), is led by Andrew Solomon, MD, as chair, with Jeffrey Cohen, MD, as co-chair. The consortium includes representatives from key multiple sclerosis (MS) organizations, such as the MS International Federation, the Consortium of MS Centers, and the European Committee for Treatment and Research in MS (ECTRIMS). In addition to developing updated general guidelines for MS differential diagnosis, the MSDDC is also working on forthcoming recommendations tailored to different geographic regions and underrepresented populations, aiming to refine diagnostic accuracy worldwide.1
As part of these ongoing efforts, a recent review led by ACTRIMS provides specific guidance on diagnosing MS in individuals under 18 and adults over 50. Developed by an international team of 19 MS experts from North America, Europe, and Latin America, the comprehensive review—published in JAMA Neurology—addresses the unique challenges of diagnosing MS in these age groups, where presentations can be atypical. The article includes detailed figures and tables highlighting frequently encountered MS mimics, as well as clinical and imaging red flags that may suggest an alternative diagnosis.2-5 ACTRIMS noted that these new guidelines serve as a key supplement to the 2024 revision of the McDonald criteria, which was presented at the 40th ECTRIMS Congress.
Following the recent 2025 ACTRIMS Forum, held February 27 to March 1 in West Palm Beach, Florida, MS expert Solomon, a neurologist at the University of Vermont (UVM) Medical Center, spoke with NeurologyLive® about the significant work of the MS Differential Diagnosis Consortium. In the interview, Solomon, who also serves as a professor of neurological sciences at the Larner College of Medicine at UVM, discussed the persistent challenges of MS misdiagnosis, the limitations of current biomarkers, and the necessity of a structured diagnostic approach that carefully evaluates alternative conditions.
Click here for coverage of 2025 ACTRIMS Forum.
REFERENCES
1. Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Outlines Guidance for Diagnosing Pediatric and Late-Onset Multiple Sclerosis. News Release. ACTRIMS. Published September 26, 2024. Accessed March 20, 2025. https://actrims.memberclicks.net/assets/2024/JAMA%20Neuro_Differential%20Diagnosis_Final_Sept%2016%2C%202024.pdf
2. Solomon AJ, Arrambide G, Brownlee WJ, et al. Differential diagnosis of suspected multiple sclerosis: an updated consensus approach. Lancet Neurol. 2023;22(8):750-768. doi:10.1016/S1474-4422(23)00148-5
3. Hua LH, Solomon AJ, Tenembaum S, et al. Differential Diagnosis of Suspected Multiple Sclerosis in Pediatric and Late-Onset Populations: A Review. JAMA Neurol. Published online September 16, 2024. doi:10.1001/jamaneurol.2024.3062
4. Amezcua L, Rotstein D, Shirani A, et al. Differential diagnosis of suspected multiple sclerosis: considerations in people from minority ethnic and racial backgrounds in North America, northern Europe, and Australasia. Lancet Neurol. 2024;23(10):1050-1062. doi:10.1016/S1474-4422(24)00288-6
5. Correale J, Solomon AJ, Cohen JA, et al. Differential diagnosis of suspected multiple sclerosis: global health considerations. Lancet Neurol. 2024;23(10):1035-1049. doi:10.1016/S1474-4422(24)00256-4
