In a clinical review conducted by an international committee of multiple sclerosis (MS) experts in pediatric and adult MS and published online Sept. 16 in JAMA Neurology, consensus guidance is provided for diagnosing pediatric and late-onset MS.
Le H. Hua, M.D., from the Lou Ruvo Center for Brain Health at the Cleveland Clinic in Las Vegas, and colleagues provide guidance on approaches to differential diagnosis in suspected MS specific to those aged younger than 18 years and older than 50 years.
The authors note that compared with typical adult-onset MS, unique biological factors are seen in children younger than 18 years and adults older than 50 years. These biological differences may influence clinical presentation, resilience to neuronal injury, and differential diagnosis.
Children have high immunological reactivity, increasing the likelihood of other mimicking disorders; consequently, MS needs to be differentiated from other neuroimmunological conditions. The clinical disease course of MS is distinct in children; progressive onset at presentation should warrant investigation for alternative diagnoses.
Children are likely to reach disability milestones at earlier ages than adults, underscoring the need for early diagnosis to allow for timely intervention. In older adults, MS should be differentiated from more common conditions such as vascular disease, spinal stenosis/compressive myelopathy, and arthritis.
Since inflammatory activity is reduced during older age, relapses triggered by inflammation occur less often, but disability progression tends to accelerate. Nonspecific white matter changes in the brain in older populations are more likely due to vascular disease or migraines, potentially leading to misdiagnosis of MS.
“There are important implications for when MS treatment begins, and improving diagnostic approach is an important step forward in providing tailored care as our research into these patient subsets continues,” Hua said in a statement.
More information:
Le H. Hua et al, Differential Diagnosis of Suspected Multiple Sclerosis in Pediatric and Late-Onset Populations, JAMA Neurology (2024). DOI: 10.1001/jamaneurol.2024.3062
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Guidelines provided for diagnosis of pediatric, late-onset multiple sclerosis (2024, September 25)
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