ImportanceWhile the typical onset of multiple sclerosis (MS) occurs in early adulthood, 2% to 10% of cases initially present prior to age 18 years, and approximately 5% after age 50 years. Guidance on approaches to differential diagnosis in suspected MS specific to these 2 age groups is needed.ObservationsThere are unique biological factors in children younger than 18 years and in adults older than age 50 years compared to typical adult-onset MS. These biological differences, particularly immunological and hormonal, may influence the clinical presentation of MS, resilience to neuronal injury, and differential diagnosis. While mimics of MS at the typical age at onset have been described, a comprehensive approach focused on the younger and older ends of the age spectrum has not been previously published.Conclusions and RelevanceAn international committee of MS experts in pediatric and adult MS was formed to provide consensus guidance on diagnostic approaches and key clinical and paraclinical red flags for non-MS diagnosis in children and older adults.

中文翻译：

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儿童和晚发人群疑似多发性硬化症的鉴别诊断


重要性虽然多发性硬化症 （MS） 的典型发作发生在成年早期，但 2% 至 10% 的病例最初出现在 18 岁之前，大约 5% 的病例在 50 岁之后出现。需要对这 2 个年龄组的疑似 MS 进行鉴别诊断的方法指导。观察结果与典型的成人发病 MS 相比，18 岁以下的儿童和 50 岁以上的成人存在独特的生物学因素。这些生物学差异，尤其是免疫学和激素学差异，可能会影响 MS 的临床表现、对神经元损伤的恢复力和鉴别诊断。虽然已经描述了典型发病年龄的 MS 模拟物，但以前尚未发表针对年龄范围的年轻和老年端的综合方法。结论和相关性成立了一个由儿童和成人 MS 专家组成的国际委员会，旨在为儿童和老年人非 MS 诊断的诊断方法和关键临床和辅助临床危险信号提供共识指导。