The DOI matches its Crossref record; 85 of the 85 references it cites were found in a registry or an index; 65 of the 151 sources its claims cite were checked for support.
Diagnosis of multiple sclerosis: progress and challenges
Open accessAbstract
The diagnosis of multiple sclerosis is based on neurological symptoms and signs, alongside evidence of dissemination of CNS lesions in space and time. MRI is often sufficient to confirm the diagnosis when characteristic lesions accompany a typical clinical syndrome, but in some patients, further supportive information is obtained from cerebrospinal fluid examination and neurophysiological testing. Differentiation is important from other diseases in which demyelination is a feature (eg, neuromyelitis optica spectrum disorder and acute disseminated encephalomyelitis) and from non-demyelinating disorders such as chronic small vessel disease and other inflammatory, granulomatous, infective, metabolic, and genetic causes that can mimic multiple sclerosis. Advances in MRI and serological and genetic testing have greatly increased accuracy in distinguishing multiple sclerosis from these disorders, but misdiagnosis can occur. In this Series paper we explore the progress and challenges in the diagnosis of multiple sclerosis with reference to diagnostic criteria, important differential diagnoses, controversies and uncertainties, and future prospects.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This review summarizes progress and challenges in diagnosing multiple sclerosis, emphasizing McDonald 2010 clinical/MRI criteria, differential diagnosis, and emerging biomarkers. It highlights that MRI enables earlier diagnosis but can be misapplied, with misdiagnosis rates as high as 10% and several unresolved controversies.
Key findings
- MS diagnosis requires objective evidence of CNS lesions disseminated in time and space; McDonald 2010 criteria allow a diagnosis of RRMS in up to one third of clinically isolated syndrome patients with a single MRI, and MRI is abnormal in virtually all patients with established MS and over 80% of CIS patients who develop MS.
- RRMS accounts for 85–90% of patients, with mean age at onset 30 years and women affected three times as commonly as men; PPMS accounts for 10–15%, with mean age at onset 40 years and no gender bias. Spinal cord lesions occur in 80–90% of established MS and up to half of CIS patients, while CSF oligoclonal bands are found in up to 90% of people with MS but less than 20% of NMOSD patients.
- Differential diagnosis includes NMOSD, ADEM, and non-demyelinating mimics; NMOSD is approximately 100 times less common than MS in European and North American populations, about 70% of relapsing NMOSD patients are AQP4-IgG positive, and NMOSD shows a female:male ratio up to 9:1 with mean age at onset 39 years. Misdiagnosis rates may be as high as 10%, with common misdiagnosed disorders including small-vessel cerebrovascular disease, migraine, fibromyalgia, and functional neurological disorders.
- A third of radiologically isolated syndrome patients develop clinical symptoms within the first 5 years; 30–60% of patients presenting with atypical demyelinating lesions develop MS; up to 5% of people with MS develop first symptoms in childhood. Future directions include MAGNIMS-proposed modifications, cortical lesions, the central vein sign, novel CSF/body fluid biomarkers, and optical coherence tomography.
Methods
- Narrative review with a literature search of MEDLINE from 01 January 1995 to 15 May 2016 using the terms “multiple sclerosis”, “neuromyelitis optica”, “acute disseminated encephalomyelitis”, “diagnosis”, “diagnostic criteria”, and “differential diagnosis” for English-language articles; additional articles were sought from reference lists, with priority given to new studies published in the last 5 years.
- No primary data collection or formal meta-analysis; the paper synthesizes diagnostic criteria, important differential diagnoses, current controversies and uncertainties, and future prospects.
Limitations
- Paper states: McDonald MRI criteria are intended for patients in whom MS is clinically suspected, not to differentiate MS from other neurological disorders; the criteria have not been investigated in patients older than 50 years; misdiagnosis can occur (rates as high as 10%); the roles of spinal cord imaging and CSF examination remain controversial; and gadolinium safety concerns are under regulatory review.
- Evident from the text: this is a narrative review with expert-selected literature and consensus recommendations rather than a systematic review, and the search was limited to MEDLINE, English-language articles, and the period 1995–2016, so other evidence may be missed.
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Claims the paper makes
49 No full text of the sources · 30 Supported · 21 Partly supported · 18 No basis given · 10 Own interpretation · 6 Supported so far · 4 Own method · 3 Sources not found · 1 Not checked yet · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Magnetic resonance imaging (MRI) is often sufficient to confirm the diagnosis when characteristic lesions of MS accompany a typical clinical syndrome”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Abstract
What the sources say
- Partly supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol sourceExperimental — accuracy not yet measured
In the Recommended Modifications section (page unavailable), the paper says a single MRI can establish MS in some patients with a typical clinically isolated syndrome, provided the scan demonstrates dissemination in space and time. The claim omits those imaging requirements and says MRI is often sufficient whenever characteristic lesions accompany a typical syndrome; the paper supports the narrower statement, not that broader one. (LLM, conf=0.86)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The diagnosis of multiple sclerosis (MS) is based on typical neurological symptoms and signs along with evidence of dissemination of central nervous system (CNS) lesions in space and time.”
- Also stated in: § Introduction · plain
“Currently, the diagnosis is based on clinical symptoms and signs and magnetic resonance imaging (MRI), which is highly sensitive to the detection of characteristic CNS lesions. 1”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Abstract
What the sources say
- Supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol source
The Considerations Related to Revisions section says MS diagnosis can rest on objective evidence that lesions are disseminated in space and time, established clinically or through clinical and MRI findings. The same section calls correct interpretation of neurological symptoms and signs a fundamental prerequisite for diagnosis. Page numbers were not provided in our copy. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Introduction · plain
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Using the McDonald 2010 criteria a diagnosis of RRMS can be made in up to one third of CIS patients with a single MRI scan.19”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Partly supportedcites [19] Brownlee, 2015, Earlier and more frequent diagnosis of multiple sclerosis using the McDonald criteria, J Neurol Neurosurg Psychiatry sourceExperimental — accuracy not yet measured
The Results (page unavailable) show that the 2010 McDonald criteria identified MS in CIS patients using MRI evidence, including 36 of 157 patients (23%) with MRI-only MS after six years. The Methods (page unavailable) required at least one follow-up MRI, so these findings do not establish that up to one third of all CIS patients could be diagnosed from a single scan. The paper also reports MS diagnosis, not specifically RRMS diagnosis. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The McDonald criteria provide separate recommendations for the diagnosis of PPMS which include CSF abnormalities in addition to MRI. 1”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol source
In “Making a Diagnosis of Primary Progressive Multiple Sclerosis,” the panel gives PPMS-specific recommendations requiring one year of disease progression plus two of three findings: brain MRI lesions, spinal cord MRI lesions, or positive CSF. It explicitly recommends retaining the MRI-or-CSF findings requirement in the 2010 criteria. CSF is an option within that requirement, not mandatory in every PPMS diagnosis. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Occasionally, MS presents with an atypical demyelinating lesion characterised by their large size (>2cm diameter, sometimes with peri-lesional oedema and mass effect), enhancement pattern (open or closed-ring enhancement) or morphology (infiltrative or heterogeneous appearance including concentric rings).[38][39][40]”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
What the sources say
- Partly supportedcites [38] Wallner-Blazek, 2013, Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis, J Neurol sourceExperimental — accuracy not yet measured
The Introduction (page not available in our copy) says atypical demyelinating lesions can occur at the onset or during the course of relapsing-remitting disease and describes infiltrative, Baló-like and ring-like subtypes. It does not establish the claimed >2 cm threshold, peri-lesional oedema or mass effect, open versus closed-ring enhancement, or heterogeneous appearance. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [39] Seewann, 2008, MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain: A review of reported findings, J Neurol source
- Supportedcites [40] Lucchinetti, 2008, Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis, Brain source
The Introduction and Discussion (Radiographic presentations; page not provided) describe atypical demyelinating lesions larger than 2 cm, sometimes with perilesional oedema or mass effect, and with ring or heterogeneous enhancement. The Results document both open and closed rings; the Discussion also reports a concentric pattern and lesions that can mimic an infiltrative tumour. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“NMOSD is an inflammatory astrocytopathy of the CNS with clinical and radiological features that overlap with MS. 4”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [4] Wingerchuk, 2015, International consensus diagnostic criteria for neuromyelitis optica spectrum disorders, Neurology source
The Abstract describes NMO as an inflammatory CNS disorder, and the Pathology section reports findings supportive of astrocytopathy in AQP4-IgG-positive NMOSD. The Clinical presentation and Consensus diagnostic criteria sections describe clinical features shared with MS and MRI lesions that can meet MS criteria. The paper also emphasizes that the disorders are distinct. (LLM, conf=0.88)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Atypical demyelinating lesions are also seen in NMOSD and ADEM.41”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
What the sources say
- Supportedcites [41] Hardy, 2016, Atypical inflammatory demyelinating syndromes of the CNS, Lancet Neurol source
The NMOSD section (p. 8) describes tumefactive white-matter lesions, and the ADEM section (p. 13) states that tumefactive demyelinating lesions can occur in ADEM. Together, these passages support the claim that atypical demyelinating lesions are seen in both conditions. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A third of RIS patients will develop clinical symptoms in the first 5 years of follow up (either a relapse or progressive symptoms).29”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
What the sources say
- Supportedcites [29] Okuda, 2014, Radiologically isolated syndrome: 5-year risk for an initial clinical event, PLoS One source
The Results report a 34% five-year rate of a first acute or progressive clinical event in the RIS cohort. This supports the claim’s approximation of one third and its inclusion of both acute and progressive symptoms. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The McDonald criteria identify a subgroup of patients with a single attack and MRI evidence of dissemination in time and space who do not experience further relapses even with long-term follow-up.71”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
What the sources say
- Supportedcites [71] Chard, 2011, MRI only conversion to multiple sclerosis following a clinically isolated syndrome, J Neurol Neurosurg Psychiatry source
The Abstract reports that about 10–15% of patients with a clinically isolated syndrome met MRI criteria for MS without further clinical events over follow-up of up to 20 years. The Clinical assessment section defines this radiologically defined group as meeting McDonald MRI criteria for dissemination in space and time but not the criteria for clinically definite MS. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The major disorders identified that were misdiagnosed as MS were small-vessel cerebrovascular disease, migraine, fibromyalgia and functional neurological disorders.64”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Misdiagnosis of multiple sclerosis
What the sources say
- Partly supportedcites [64] Solomon, 2012, “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS, Neurology sourceExperimental — accuracy not yet measured
In “Patients misdiagnosed with MS,” respondents frequently selected small-vessel ischemic disease (78.5%), migraine (50%), and fibromyalgia (31%) as suspected alternative diagnoses. Conversion disorder appears only among free-text “other” responses, so the paper does not establish functional neurological disorders as a major category. The Discussion also cautions that these selections do not represent counts of misdiagnosed patients. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
- It may state two separate claims as one. 70
- Probably not a substantial claim. 34
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Advances in MRI, serological and genetic tests have greatly helped in distinguishing MS from these conditions, but misdiagnosis can occur.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Abstract
What the sources say
- Not checked — no full text of the sourcecites [63] Solomon, 2013, Misdiagnosis of multiple sclerosis: frequency, causes, effects, and prevention, Curr Neurol Neurosci Rep source
- Partly supportedcites [64] Solomon, 2012, “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS, Neurology sourceExperimental — accuracy not yet measured
The Discussion (page not provided) reports that MS specialists commonly encounter patients they believe were misdiagnosed and that improper interpretation of MRI findings may contribute. It does not establish that advances in MRI, serological, and genetic tests have greatly helped distinguish MS from mimicking conditions. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“PPMS (10-15% of patients) is characterised by an insidious, slowly progressive increase in neurological disability over time, usually without relapses.2”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Introduction
What the sources say
- Partly supportedcites [2] Lublin, 2014, Defining the clinical course of multiple sclerosis: the 2013 revisions, Neurology sourceExperimental — accuracy not yet measured
The KEY CONSENSUS POINTS section on PPMS describes it as a progressive course distinguished by the absence of exacerbations before clinical progression. The sections on disease activity and progression acknowledge that PPMS patients can have relapses and that progression need not be uniform. Our copy does not substantiate the claim that PPMS accounts for 10–15% of patients; searches for that figure found no supporting passage. (LLM, conf=0.85)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“It is important to differentiate MS not only from other diseases in which demyelination is a feature e.g.neuromyelitis spectrum disorder (NMOSD) and acute disseminated encephalomyelitis (ADEM), but also non-demyelinating conditions such as chronic small vessel disease and other inflammatory, granulomatous, infective, metabolic and genetic causes that can mimic MS.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Abstract
What the sources say
- Supportedcites [42] Miller, 2008, Differential diagnosis of suspected multiple sclerosis: a consensus approach, Mult Scler source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Spinal cord MRI is recommended in patients with myelopathy or when MRI brain findings are not diagnostic of MS. 12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The paper’s ‘Statements and recommendations’ section says spinal cord MRI should always be performed for spinal cord symptoms at disease onset and is helpful when brain MRI results are equivocal or inconclusive. Table 2 also lists inconclusive or nonspecific brain MRI findings as indications. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A post-contrast T1-weighted scan is recommended in patients with brain MRI lesions, to assist in diagnosis and differential diagnosis.12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The Contrast enhancement section says that when lesions are seen on T2-weighted brain MRI, gadolinium-enhanced T1-weighted sequences are mandatory in the initial study. It says these scans distinguish acute from chronic lesions and that enhancement patterns help with differential diagnosis. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In addition to obtaining brain images with an axial orientation, a sagittal T2 fluid-attenuated inversion recovery (FLAIR) sequence is recommended for detecting juxtacortical and corpus callosum lesions, which can be helpful in differentiating MS from other disorders.12,13”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The T2-weighted sequences section recommends combining axial scans with sagittal T2-FLAIR, says T2-FLAIR improves detection of juxtacortical lesions, and explains that sagittal imaging adds information about corpus callosum lesions useful for distinguishing MS from vascular lesions. The Statements and recommendations section also includes both axial and sagittal sequences in the diagnostic protocol. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [13] Garg, 2015, The corpus callosum in the diagnosis of multiple sclerosis and other CNS demyelinating and inflammatory diseases, J Neurol Neurosurg Psychiatry source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The McDonald 2010 criteria are easily applied in a clinical setting and allow for an earlier diagnosis of MS. 19”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Partly supportedcites [19] Brownlee, 2015, Earlier and more frequent diagnosis of multiple sclerosis using the McDonald criteria, J Neurol Neurosurg Psychiatry sourceExperimental — accuracy not yet measured
The paper’s conclusion (page not specified in our copy) says the McDonald criteria allow earlier MS diagnosis in patients with a clinically isolated syndrome, and its results report a shorter mean time to diagnosis with the 2010 criteria. It does not say the criteria are easily applied in a clinical setting; the claim also omits the study’s CIS population qualifier. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Using the McDonald 2010 criteria a diagnosis of MS can still be made on clinical grounds alone; however, MRI is used to provide evidence for dissemination in time and space, including in patients with CIS. 1”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A standardised MRI protocol was recently proposed by the MAGNIMS network to assist in the diagnosis of MS. 12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The Introduction says the MAGNIMS network provides recommendations for brain and spinal cord MRI in the diagnostic process for suspected MS. The 'Standardized brain MRI protocol' section and the Conclusions explicitly describe a standardized protocol intended to improve MS diagnosis. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A major discovery was the association between neuromyelitis optica spectrum disorder (NMOSD) and serum aquaporin-4 IgG (AQP4-IgG), confirming that NMOSD is a different disease from MS requiring distinct treatments.4”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Introduction
What the sources say
- Supportedcites [4] Wingerchuk, 2015, International consensus diagnostic criteria for neuromyelitis optica spectrum disorders, Neurology source
The paper’s opening discussion describes discovery of serum AQP4-IgG in most patients with NMO as a major advance. It states that NMO is distinct from MS and that attack-prevention treatments differ; some MS immunotherapies may aggravate NMO. The paper uses NMOSD to encompass NMO and related presentations. (LLM, conf=0.93)
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Dissemination in time requires either asymptomatic gadolinium-enhancing and non-enhancing lesions on the same MRI scan or a new lesion on a follow up scan. 1”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol source
In “Recommended Modifications to the McDonald Criteria: The 2010 Revisions” (page not provided), the paper says that enhancing and nonenhancing lesions on a baseline MRI can establish dissemination in time without a follow-up scan. It also says that serial imaging showing a new enhancing or T2 lesion can establish dissemination in time. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Secondly, MRI criteria were tested and validated in European populations with a high incidence of MS 25 , although recent studies investigating the McDonald 2010 criteria in CIS cohorts in Latin America 26 and Asia 27 have reported a similarly good performance.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Not checked — no full text of the sourcecites [25] Montalban, 2010, MRI criteria for MS in patients with clinically isolated syndromes, Neurology source
- Supportedcites [26] Patrucco, 2013, Application of the McDonald 2010 criteria for the diagnosis of multiple sclerosis in an Argentinean cohort of patients with clinically isolated syndromes, Mult Scler source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [27] Huh, 2014, Evaluation of McDonald MRI criteria for dissemination in space in Korean patients with clinically isolated syndromes, Mult Scler source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“For RRMS, MRI evidence of dissemination in space requires ≥1 T2 lesion in at least two of four sitesperiventricular, juxtacortical, and infratentorial regions and the spinal cord (Figure 1), with symptomatic lesions in the brainstem and spinal cord excluded.1”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“NMOSD shows a strong gender bias (female:male ratio up to 9:1) and a mean age at onset of 39 years 46 , although all age groups can be affected including children and the elderly.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [46] Pandit, 2015, Demographic and clinical features of neuromyelitis optica: a review, Mult Scler sourceExperimental — accuracy not yet measured
The Gender ratio section reports strong female predominance, and the Effect of age section documents both pediatric and late onset. However, “up to 9:1” understates the highest ratios reported, while the mean onset age of 39 years appears in Table 2 for a German cohort, not as an overall NMOSD mean; the review gives a range of means across case series. (LLM, conf=0.85)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Most patients with NMOSD have a relapsing course with accumulation of disability over time related to poor recovery from individual attacks and a secondary progressive course is rare.45,47”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [45] Zekeridou, 2015, Aquaporin-4 autoimmunity, Neurol Neuroimmunol Neuroinflamm source
The Neurologic manifestations section describes monophasic NMO as a rare presentation, reports poor recovery from optic neuritis and myelitis attacks, and says secondary progression is rare. The Prognosis section describes severe disability developing stepwise with relapses, consistent with disability accumulating after attacks. No page numbers are available in our copy. (LLM, conf=0.85)
- Supportedcites [47] Kitley, 2012, Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan, Brain source
In Disease presentation and course (page unavailable), 86% of the AQP4-antibody-positive patients had a relapsing course, and none developed a progressive stage. The Discussion (page unavailable) reports substantial permanent visual and motor disability over follow-up; the Introduction describes disability as relapse-associated. Together, these support the claim for the population studied. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Younger age, male gender and gadolinium-enhancing, cortical or spinal cord lesions may be associated with an increased risk of developing MS.29- 31”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
What the sources say
- Partly supportedcites [29] Okuda, 2014, Radiologically isolated syndrome: 5-year risk for an initial clinical event, PLoS One sourceExperimental — accuracy not yet measured
The Results identify younger age, male sex, and cervical or thoracic spinal cord lesions as predictors of a first clinical event in RIS. However, Table 4 shows no association for juxtacortical lesions, and the Discussion explicitly says baseline contrast enhancement was not predictive. The paper therefore does not support the cortical-lesion and gadolinium-enhancement parts of the claim. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [30] Lebrun, 2009, Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients, Arch Neurol source
- Not checked — no full text of the sourcecites [31] Giorgio, 2011, Cortical lesions in radiologically isolated syndrome, Neurology source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“MRI findings include large (>1-2cm), bilateral white matter lesions and deep grey matter lesions and contrast enhancement.42”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Acute disseminated encephalomyelitis (ADEM)
What the sources say
- Supportedcites [42] Miller, 2008, Differential diagnosis of suspected multiple sclerosis: a consensus approach, Mult Scler source
In the Consensus perspectives section, the paper describes ADEM lesions as typically symmetrical and says that a lesion greater than 1–2 cm together with deep grey nuclei lesions is characteristic. Table 5 says white matter lesions may be accompanied by basal ganglia lesions and variably enhance with gadolinium; neither deep grey involvement nor enhancement is required. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“At this time it is considered essential that a diagnosis of MS only be made in a patient who has symptoms suggestive of demyelination. 2”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
What the sources say
- Supportedcites [2] Lublin, 2014, Defining the clinical course of multiple sclerosis: the 2013 revisions, Neurology source
In “New disease courses,” the paper says clinical evidence of demyelinating disease is a current criterion for MS diagnosis. It therefore does not classify radiologically isolated syndrome—imaging findings without clinical signs or symptoms—as an MS subtype. The paper says “signs or symptoms,” rather than requiring symptoms specifically. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“While some patients presenting with atypical demyelinating lesions have a monophasic course, 30-60% develop MS. 38,40”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
What the sources say
- Partly supportedcites [38] Wallner-Blazek, 2013, Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis, J Neurol sourceExperimental — accuracy not yet measured
The Results report that two-thirds or more of most lesion subgroups had no further attack during follow-up, supporting the possibility of a single-attack course. They also report new MS-typical MRI lesions in 29 of 69 patients (42%), but do not say that 30–60% developed a diagnosis of MS. The distinction between new lesions and an MS diagnosis limits support for that part of the claim. (LLM, conf=0.85)
- Partly supportedcites [40] Lucchinetti, 2008, Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis, Brain sourceExperimental — accuracy not yet measured
The Results (Clinical characteristics of the cohort; page not provided) report that 24% had a monophasic course, supporting the first part of the claim. They report that 70% developed definite multiple sclerosis, not 30–60%; they also note that a monophasic course did not preclude an MS diagnosis. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“NMOSD is approximately 100 times less common than MS in European and North American populations but is relatively more common in Asia and Africa where MS is less common.46”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [46] Pandit, 2015, Demographic and clinical features of neuromyelitis optica: a review, Mult Scler sourceExperimental — accuracy not yet measured
The Prevalence section (page unavailable) reports that NMO prevalence varies across geographic and ethnic cohorts, and the Atlas of MS Database section gives figures for European countries, Japan, South Africa, and Southeast Asia. Neither section establishes that NMOSD is approximately 100 times less common than MS in Europe and North America, or that its frequency relative to MS is higher across Asia and Africa. (LLM, conf=0.77)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“MRI might help predict outcome; the presence of typical MS lesions and a closed-ring enhancement pattern have been associated with a higher risk of MS. 38”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
What the sources say
- Partly supportedcites [38] Wallner-Blazek, 2013, Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis, J Neurol sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) links additional MS-typical MRI lesions to a higher likelihood of having or developing MS. The Results and Discussion also report more subsequent attacks among patients with ring-like lesions, but the copy does not establish that a specifically closed-ring enhancement pattern predicts a higher risk of MS. (LLM, conf=0.87)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“An accurate diagnosis of NMOSD is essential since prompt treatment of acute attacks and long-term immunosuppression appear to reduce disability, while conventional MS treatments may aggravate NMOSD.44,48”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [44] Trebst, 2014, Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS), J Neurol source
The Therapy sections recommend early treatment of attacks and prompt long-term immunosuppression after diagnosis; the long-term treatment section reports stable or reduced disability with mycophenolate in patients with NMOSD. It also reports exacerbation or deterioration with interferon-beta, natalizumab, and fingolimod, supporting the qualified warning about MS treatments. Page numbers are not available in our copy. (LLM, conf=0.91)
- Supportedcites [48] Kimbrough, 2012, Treatment of Neuromyelitis Optica: Review and Recommendations, Mult Scler Relat Disord source
The Introduction says diagnostic criteria distinguish NMO from MS and that NMOSD is treated identically to NMO. The acute-treatment section calls for treating attacks as soon as symptoms arise; the Summary says preventive treatments appear to stabilize disability; and Preventative Therapy: General Principles reports possible harmful effects of MS immunomodulators. The supplied passages do not provide page numbers. (LLM, conf=0.91)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The identification of a pathogenic IgG antibody directed against the aquaporin-4 (AQP4-IgG) water channel has established NMOSD as a specific disease entity that needs to be differentiated from MS because of important differences in prognosis and treatment.44,45”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [44] Trebst, 2014, Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS), J Neurol source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Supportedcites [45] Zekeridou, 2015, Aquaporin-4 autoimmunity, Neurol Neuroimmunol Neuroinflamm source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The differential diagnosis of MS is broad and many neurologists use the approach of identifying”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Differential diagnosis of MS
What the sources say
- Partly supportedcites [42] Miller, 2008, Differential diagnosis of suspected multiple sclerosis: a consensus approach, Mult Scler sourceExperimental — accuracy not yet measured
The Discussion/conclusions says the range of diseases to exclude in MS diagnosis is wide, and Methods > Exclusion of diagnostic alternatives describes clinical, imaging, and laboratory red flags that point away from MS. The paper presents this as a consensus approach, but does not establish that many neurologists use it in practice; no page numbers are available in our copy. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A history of autoimmunity including thyroid disease and connective tissue disorders (e.g.systemic lupus erythematosus, Sjogren's syndrome) is not uncommon.45”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [45] Zekeridou, 2015, Aquaporin-4 autoimmunity, Neurol Neuroimmunol Neuroinflamm source
The ‘Coexisting autoimmune disorders’ section says autoimmune manifestations are frequent with NMOSD. It names Sjögren syndrome and systemic lupus erythematosus as common accompaniments and also reports autoimmune thyroiditis. (LLM, conf=0.94)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Diagnostic criteria for NMOSD have recently been updated (Supplementary Panel 2 ).47”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [47] Kitley, 2012, Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan, Brain sourceExperimental — accuracy not yet measured
The References list revised diagnostic criteria for neuromyelitis optica (NMO) from 2006. But the Discussion says incorporating broader NMO spectrum disorder phenotypes into those criteria still needs debate; it does not report an update to NMOSD diagnostic criteria. Page numbers are unavailable in our copy. (LLM, conf=0.83)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In a survey of MS specialist neurologists in the United States, 95% of respondents had seen one or more patients in the previous year who had been misdiagnosed with MS, many of whom were being treated inappropriately with disease-modifying therapies.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Misdiagnosis of multiple sclerosis
What the sources say
- Supportedcites [64] Solomon, 2012, “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS, Neurology source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Current guidelines recommend spinal cord MRI in patients with symptoms of myelopathy or when brain MRI findings are not diagnostic of MS. 12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The “Statements and recommendations” section says spinal cord MRI should always be performed for patients with spinal cord symptoms at disease onset and is helpful when brain MRI is equivocal or inconclusive. Table 2 also lists inconclusive or nonspecific brain MRI findings among the indications for spinal cord MRI. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“MOG-IgG is also found in some patients with ADEM (particularly in children), and in ADEM followed by optic neuritis, and isolated or recurrent optic neuritis.58,59”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [58] Kim, 2015, Antibodies to MOG in adults with inflammatory demyelinating disease of the CNS, Neurol Neuroimmunol Neuroinflamm sourceExperimental — accuracy not yet measured
The Discussion reports MOG antibodies in pediatric ADEM cohorts and in 1 of 8 adults with clinical features of ADEM. The Results describe both isolated and recurrent optic neuritis in MOG-antibody-positive patients. Neither section establishes the specific sequence of ADEM followed by optic neuritis. (LLM, conf=0.86)
- Partly supportedcites [59] Hacohen, 2015, Myelin oligodendrocyte glycoprotein antibodies are associated with a non-MS course in children, Neurol Neuroimmunol Neuroinflamm sourceExperimental — accuracy not yet measured
The Results (page unavailable) report MOG antibodies in 4/12 children presenting with ADEM and 12/24 presenting with optic neuritis. The Discussion mentions recurrent optic neuritis as a possible MOG-positive phenotype, but our copy does not document ADEM followed by optic neuritis or establish recurrent optic neuritis among this cohort’s antibody-positive cases. (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Although the first attack of NMOSD can mimic CIS (e.g.acute unilateral optic neuritis or short-segment partial myelitis 61 ), routine testing for AQP4-IgG in CIS populations with a high incidence of MS and low incidence of NMOSD has a very low yield and is not recommended.62”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Supportedcites [61] Flanagan, 2015, Short myelitis lesions in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders, JAMA Neurol source
Citation 61 is attached to the example of short-segment myelitis as a first NMOSD attack, not to the testing recommendation, which carries citation 62. The Results report short transverse myelitis as the first manifestation of NMOSD, and the Discussion notes that some patients were initially diagnosed with MS. Page numbers are not available in our copy. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [62] Costa, 2012, Value of NMO-IgG determination at the time of presentation as CIS, Neurology source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Therefore routine imaging of the whole spinal cord in all patients with suspected MS has recently been proposed.68”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Partly supportedcites [68] Filippi, 2016, MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines, Lancet Neurol sourceExperimental — accuracy not yet measured
The Methods section (‘Spinal cord imaging’; page unavailable) recommends imaging the entire cord when spinal cord MRI is used to assess dissemination in space. It recommends spinal cord imaging at symptom onset for specified patient groups, however, not routinely for all patients with suspected MS. (LLM, conf=0.88)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Using the McDonald criteria, MS is being diagnosed significantly earlier than with the use of clinical criteria alone facilitating earlier treatment.19”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
What the sources say
- Partly supportedcites [19] Brownlee, 2015, Earlier and more frequent diagnosis of multiple sclerosis using the McDonald criteria, J Neurol Neurosurg Psychiatry sourceExperimental — accuracy not yet measured
The results (page unavailable) report significantly earlier MS diagnosis with McDonald criteria than with clinical criteria in patients with clinically isolated syndrome. The discussion says earlier diagnosis allows timely conversations about disease-modifying treatment, but does not establish that treatment began earlier. (LLM, conf=0.86)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Gadolinium-enhancing lesions provide evidence for dissemination in time and can also assist in differential diagnosis.1,12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Partly supportedcites [1] Polman, 2011, Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria, Ann Neurol sourceExperimental — accuracy not yet measured
In Recommended Modifications to the McDonald Criteria, the paper says that gadolinium-enhancing lesions together with nonenhancing lesions can establish dissemination in time on a single scan, provided the enhancement is not due to non-MS pathology. It discusses differential diagnosis elsewhere, but does not say that gadolinium-enhancing lesions themselves assist in distinguishing MS from other conditions. (LLM, conf=0.86)
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The Contrast enhancement section states that gadolinium-enhanced imaging distinguishes acute from chronic lesions and can demonstrate dissemination in time. It also says the pattern of enhancement can help differentiate MS from conditions that mimic it. (LLM, conf=0.95)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The McDonald 2010 criteria do not mandate a CSF examination and there is much variation between neurologists as to how often a lumbar puncture is done in in the diagnosis of MS. 66”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Supportedcites [66] Hutchinson, 2013, CSF oligoclonal bands are important in the diagnosis of multiple sclerosis, unreasonably downplayed by the McDonald criteria 2010: Commentary, Mult Scler source
The commentary (indexed under References; no page given) says a diagnosis under the 2010 criteria can be made on clinical grounds alone and that many patients are managed without CSF examination. It also says neurologists differ: some regard CSF examination as superfluous in typical cases, while others consider it essential. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Attacks of myelitis are associated with longitudinally-extensive spinal cord lesions on MRI (≥3 vertebral bodies) with prominent involvement of the central cord 49 (Supplementary Figure 4), in contrast to MS where lesions are usually short (<1-2 vertebral bodies) and located peripherally.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [49] Kim, 2015, MRI characteristics of neuromyelitis optica spectrum disorder: an international update, Neurology sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Approximately 70% of patients with relapsing NMOSD are AQP4-IgG positive, with the sensitivity increased with the use of cell-based rather than ELISA assays.53,54”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Partly supportedcites [53] Waters, 2012, Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays, Neurology sourceExperimental — accuracy not yet measured
The Abstract reports AQP4-IgG detection in roughly 70% of the combined NMO/NMOSD cohort and higher sensitivity for cell-based assays than for ELISA. The Methods describe some patients with recurrent disease, but the reported percentages are for the combined cohort, not specifically patients with relapsing NMOSD. (LLM, conf=0.87)
- Not checked — no full text of the sourcecites [54] Pittock, 2014, Seroprevalence of aquaporin-4-IgG in a northern California population representative cohort of multiple sclerosis, JAMA Neurol source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Current guidelines recommend a post-contrast T1weighted scan as part of the diagnostic evaluation of patients with suspected MS. 12”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Supportedcites [12] Rovira, 2015, Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process, Nat Rev Neurol source
The Statements and recommendations section includes T1-weighted imaging before and after contrast in the standardized diagnostic MRI protocol. The Contrast enhancement section qualifies that contrast is not required if no lesions are detected, but recommends contrast-enhanced T1-weighted imaging in the initial study when T2 lesions are present. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Despite the current usefulness of the McDonald criteria, the MAGNIMS network have recently proposed a number of modifications, such as inclusion of optic nerve, cortical and symptomatic lesions in dissemination in space and standardisation of dissemination in space criteria for RRMS, PPMS and RIS.68”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Conclusions and future perspectives
What the sources say
- Supportedcites [68] Filippi, 2016, MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines, Lancet Neurol source
The “Recommended modifications to the criteria” section proposes adding the optic nerve to DIS, grouping cortical and juxtacortical lesions, and making no distinction between symptomatic and asymptomatic lesions. It also recommends identical DIS criteria for primary progressive and relapse-onset MS, and applying the same MRI DIS criteria to RIS. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Some of these recommendations are evidence-based 73,74 and others are based on expert consensus.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Conclusions and future perspectives
What the sources say
- Not checked — no full text of the sourcecites [73] Filippi, 2010, Intracortical lesions: relevance for new MRI diagnostic criteria for multiple sclerosis, Neurology source
- Supportedcites [74] Brownlee, 2016, Should the symptomatic region be included in dissemination in space in MRI criteria for MS?, Neurology source
The citation is attached to the statement that some recommendations are evidence-based, not to the separate statement about expert consensus. In the Discussion, Brownlee et al. say their study provides evidence supporting a recommendation to include lesions in the symptomatic region in MRI dissemination-in-space criteria. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Clinical features that suggest demyelination as the cause of such an episode include age <40 years, an acute/subacute onset over hours to days, maximal deficit within 4 weeks of onset and spontaneous remission.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Presenting symptoms of MS
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Non-specific antibodies are frequently detected that may not be clinically relevant with low-titre antinuclear antibodies (ANA) particularly prevalent in patients with MS. 17”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [17] Negrotto, 2015, Should we systematically test patients with clinically isolated syndrome for auto-antibodies?, Mult Scler source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The onset of PPMS in contrast is characterised by slowly progressive symptoms, most often an asymmetric paraparesis that evolves over months or years 6 or, less commonly, a progressive hemiparesis or cerebellar ataxia or very rarely, visual failure or dementia.6”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Presenting symptoms of MS
What the sources say
- Not checked — no full text of the sourcecites [6] Miller, 2007, Primary-progressive multiple sclerosis, Lancet Neurol source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Common CIS presentations include acute unilateral optic neuritis, a partial myelitis or a brainstem syndrome.5”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Presenting symptoms of MS
What the sources say
- Not checked — no full text of the sourcecites [5] Brownlee, 2014, Clinically isolated syndromes and the relationship to multiple sclerosis, J Clin Neurosci source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Progressive worsening over a period of at least 12 months provides evidence of dissemination in time.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“The McDonald MRI criteria were developed and tested in CIS patients with symptoms typical of MS (e.g.unilateral optic neuritis) and they should not be applied to patients with non-specific neurological symptoms such as paraesthesia, dizziness or headache, in which the diagnosis is much less likely.23”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
- Not checked — no full text of the sourcecites [23] Selchen, 2012, MS, MRI, and the 2010 McDonald criteria: a Canadian expert commentary, Neurology source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“PPMS typically presents at an older age than RRMS (mean age at onset 40 years) and there is no gender bias.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Introduction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“The widespread use of MRI means incidental findings suggestive of MS are sometimes identified in some people who have no clinical symptoms.This is referred to as a radiologically isolated syndrome (RIS).28”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
What the sources say
- Not checked — no full text of the sourcecites [28] Okuda, 2009, Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome, Neurology source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Advances in MRI, immunological and genetic tests have improved the diagnosis of other conditions that can be mistaken for MS.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“OCBs are found in up to 90% of people with MS (less often in CIS patients) 15 and sometimes in other neuroinflammatory disorders and their presence needs to be interpreted carefully.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [15] Dobson, 2013, Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude, J Neurol Neurosurg Psychiatry source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“When a patient presents with symptoms or signs that could indicate MS, an MRI is essential as an abnormal brain MRI is seen in virtually all patients with established MS 7 and over 80% of CIS patients who develop MS. 8”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [7] Offenbacher, 1993, Assessment of MRI criteria for a diagnosis of MS, Neurology source
- Not checked — no full text of the sourcecites [8] Fisniku, 2008, Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis, Brain source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Brain T2 lesion load tends to be lower in PPMS 6 and the combination of MRI and CSF findings provides a higher sensitivity than MRI alone.20”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Diagnostic criteria for MS and their application in clinical settings
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Spinal cord lesions occur in 80-90% of patients with established MS and up to half of patients with CIS, most often in the cervical cord.10,11”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [10] Sombekke, 2013, Spinal cord lesions in patients with clinically isolated syndrome: a powerful tool in diagnosis and prognosis, Neurology source
- Not checked — no full text of the sourcecites [11] Bot, 2002, Differentiation of multiple sclerosis from other inflammatory disorders and cerebrovascular disease: value of spinal MR imaging, Radiology source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“MRI is also helpful in excluding other pathologies, for example, a compressive lesion in a patient with a progressive myelopathy, or identifying abnormalities that suggest an alternative diagnosis (e.g.leptomeningeal enhancement, longitudinally-extensive spinal cord lesion).”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“CSF findings in MS include a normal or mildly raised white cell count (<25 cells/cm 3 , predominantly lymphocytes) and protein (usually <1g/L), a raised IgG index and IgG oligoclonal bands (OCBs) not present in serum.14”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [14] Freedman, 2005, Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement, Arch Neurol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The initial presentation of MS is varied and depends both on the location of lesions within the CNS and their onset (relapsing or progressive).”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Presenting symptoms of MS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“A prolonged latency and well-preserved waveform on evoked potential testing is suggestive of demyelination but is not specific.16”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
What the sources say
- Not checked — no full text of the sourcecites [16] Leocani, 2014, Clinical neurophysiology of multiple sclerosis, Handb Clin Neurol source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In most patients with a typical clinical picture and MRI findings a Cerebrospinal fluid (CSF) examination is usually not necessary, but can provide supportive evidence of MS.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Approach to investigating patients with suspected MS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, patients with RIS are at significant risk for developing MS and should be counselled and offered follow up as appropriate.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“Brain lesions in MS are typically small (<1cm diameter) and ovoid with a homogenous signal on T2-weighted sequences.9”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
What the sources say
- Not checked — no full text of the sourcecites [9] Fazekas, 1999, The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis, Neurology source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In younger children (<12 years) MS may present differently from adolescents and adults; encephalopathy, multifocal neurological deficits (often with prominent brainstem/cerebellar involvement) and seizures are more common.32”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in children
What the sources say
- Not checked — no full text of the sourcecites [32] Krupp, 2013, International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions, Mult Scler source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“ADEM is almost always monophasic; however, an encephalopathic ADEM-like illness can sometimes be the first presentation of MS in both children 32,34 and adults 43 and diagnostic criteria for ADEM remain imperfect.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Acute disseminated encephalomyelitis (ADEM)
What the sources say
- Not checked — no full text of the sourcecites [32] Krupp, 2013, International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions, Mult Scler source
- Not checked — no full text of the sourcecites [34] Peche, 2013, A long-term follow-up study using IPMSSG criteria in children with CNS demyelination, Pediatr Neurol source
- Not checked — no full text of the sourcecites [43] Schwarz, 2001, Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients, Neurology source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In this age group males are over-represented and a progressive onset is more common.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in older adults
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In this situation a stringent interpretation of brain MRI criteria for MS is mandatory and spinal cord MRI is helpful since spinal cord lesions do not occur with healthy aging.11”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in older adults
What the sources say
- Not checked — no full text of the sourcecites [11] Bot, 2002, Differentiation of multiple sclerosis from other inflammatory disorders and cerebrovascular disease: value of spinal MR imaging, Radiology source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There are no accepted diagnostic criteria for RIS, but the Okuda 2009 criteria 28”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > The radiologically isolated syndrome
What the sources say
- Not checked — no full text of the sourcecites [28] Okuda, 2009, Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome, Neurology source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A CSF examination looking for OCBs can also be particularly helpful in older adults, as may visual evoked potentials.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in older adults
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“Up to 5% of people with MS develop their first symptoms in childhood, almost always RRMS. 32”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in children
What the sources say
- Not checked — no full text of the sourcecites [32] Krupp, 2013, International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions, Mult Scler source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The performance of the McDonald 2010 criteria has been tested in children with CIS and the criteria have a similar sensitivity/specificity for the development of MS as in adult populations 35 but should not be applied in the setting of encephalopathy (i.e.ADEM).32”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in children
What the sources say
- Not checked — no full text of the sourcecites [35] Sadaka, 2012, 2010 McDonald criteria for diagnosing pediatric multiple sclerosis, Ann Neurol source
- Not checked — no full text of the sourcecites [32] Krupp, 2013, International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions, Mult Scler source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Studies investigating MRI criteria for a diagnosis of MS have typically excluded patients older than 50 years and the McDonald criteria have not been investigated in this group.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MS in older adults
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“The clinical, imaging and laboratory features of ADEM and MS overlap and diagnostic criteria emphasise the requirement of encephalopathy (altered level of consciousness, behavioural or cognitive change) in making the diagnosis of ADEM (Supplementary Panel 1).32”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Acute disseminated encephalomyelitis (ADEM)
What the sources say
- Not checked — no full text of the sourcecites [32] Krupp, 2013, International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions, Mult Scler source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“ADEM is an inflammatory demyelinating disorder of the CNS distinct from MS that occurs mainly in childhood and is rare in adults.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Acute disseminated encephalomyelitis (ADEM)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“CSF findings include a lymphocytic pleocytosis and raised protein.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Acute disseminated encephalomyelitis (ADEM)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These lesions may have the appearance of a neoplasm (glioma, primary CNS lymphoma) or infection (brain abscess, progressive multifocal leukoencephalopathy), sometimes necessitating brain biopsy.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Atypical demyelinating lesions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Conventional brain MRI findings around the time of diagnosis are only modestly predictive of long-term disability 8 and there is uncertainty as to the extent to which criteria for diagnosis and treatment should be linked.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
What the sources say
- Not checked — no full text of the sourcecites [8] Fisniku, 2008, Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis, Brain source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Compared with MS, optic neuritis in NMOSD is more likely to be bilateral (either simultaneous or rapidly sequential) and associated with poor visual recovery.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, OCBs may provide additional prognostic information 15 and may increase diagnostic confidence, especially when considering long-term disease-modifying treatment.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Not checked — no full text of the sourcecites [15] Dobson, 2013, Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude, J Neurol Neurosurg Psychiatry source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage) and specificity (making an accurate diagnosis).”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“CSF occasionally shows features distinct from MS (white cell count >50 cells/cm 3 , neutrophils or eosinophils >5 cells/cm 3 ); however, a mild CSF pleocytosis is more common (white cell count <25 cells/cm 3 ).52”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Not checked — no full text of the sourcecites [52] Jarius, 2011, Cerebrospinal fluid findings in aquaporin-4 antibody positive neuromyelitis optica: results from 211 lumbar punctures, J Neurol Sci source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“As noted previously the sensitivity of OCBs is <100% and may be significantly lower in people with a first demyelinating event 15 , the time when a lumbar puncture is most likely to be performed.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Not checked — no full text of the sourcecites [15] Dobson, 2013, Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude, J Neurol Neurosurg Psychiatry source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, spinal cord lesions can be very helpful in making a diagnosis of MS (cord lesions do not occur with healthy aging or cerebrovascular disease 11 and provide additional evidence of dissemination in space 10 ) and may provide important prognostic information.67”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Controversies and areas of uncertainty
What the sources say
- Not checked — no full text of the sourcecites [11] Bot, 2002, Differentiation of multiple sclerosis from other inflammatory disorders and cerebrovascular disease: value of spinal MR imaging, Radiology source
- Not checked — no full text of the sourcecites [10] Sombekke, 2013, Spinal cord lesions in patients with clinically isolated syndrome: a powerful tool in diagnosis and prognosis, Neurology source
- Not checked — no full text of the sourcecites [67] Swanton, 2009, Early MRI in optic neuritis: The risk for disability, Neurology source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, the criteria are intended to provide diagnostic rather than prognostic information.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“A recently identified subgroup of AQP4-IgG seronegative NMOSD patients have antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) 56 and may have a more favourable course.50,57”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Not checked — no full text of the sourcecites [56] Kitley, 2012, Myelin-oligodendrocyte glycoprotein antibodies in adults with a neuromyelitis optica phenotype, Neurology source
- Not checked — no full text of the sourcecites [50] Ramanathan, 2016, Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis, Mult Scler source
- Not checked — no full text of the sourcecites [57] Kitley, 2014, Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study, JAMA Neurol source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The optimal balance of sensitivity and specificity using MRI criteria is uncertain.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > MRI criteria for MS require a balance between sensitivity (diagnosing MS at an early stage)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“These disorders usually present quite differently to MS and reasons for misdiagnosis included misinterpretation of clinical findings (symptoms not typical of demyelination, absence of objective neurological signs) and inappropriate application of MRI criteria.63”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Misdiagnosis of multiple sclerosis
What the sources say
- Not checked — no full text of the sourcecites [63] Solomon, 2013, Misdiagnosis of multiple sclerosis: frequency, causes, effects, and prevention, Curr Neurol Neurosci Rep source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“AQP4-IgG is highly specific for NMOSD, although false positives occur in up to 0.5% of MS patients using ELISA assays, potentially resulting in misdiagnosis.54,55”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Neuromyelitis optica spectrum disorder (NMOSD)
What the sources say
- Not checked — no full text of the sourcecites [54] Pittock, 2014, Seroprevalence of aquaporin-4-IgG in a northern California population representative cohort of multiple sclerosis, JAMA Neurol source
- Not checked — no full text of the sourcecites [55] Kister, 2015, Pushing the boundaries of neuromyelitis optica: does antibody make the disease?, Neurology source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Additional articles were also sought from the reference lists of relevant articles.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Search strategy and selection criteria
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Further supportive information from CSF and/or evoked potentials can be obtained if diagnostic uncertainty remains.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Conclusions and future perspectives
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Current diagnostic criteria for MS integrate clinical and MRI findings and enable an earlier and more reliable diagnosis of MS than with clinical findings alone, potentially facilitating earlier treatment.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Conclusions and future perspectives
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Where appropriate review articles have been referenced to provide more detailed information on individual topics.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Search strategy and selection criteria
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We searched MEDLINE (01 January 1995 -15 May 2016) using the search terms “multiple sclerosis”, “neuromyelitis optica”, “acute disseminated encephalomyelitis, “diagnosis”, “diagnostic criteria” and “differential diagnosis” for articles published in the English language.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Search strategy and selection criteria
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The criteria are best applied in an individual patient when there are typical symptoms and signs of MS and when relevant differential diagnoses have been excluded.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Conclusions and future perspectives
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Priority was given to new studies published in the last 5 years.”
§ The diagnosis and differential diagnosis of multiple sclerosis: progress and challenges > Search strategy and selection criteria
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Effective treatments for RRMS exist.
“An early and accurate diagnosis of MS is essential because there are now effective treatments for RRMS.”
The paper relies on this without support.
The McDonald 2010 criteria are the current diagnostic criteria for MS.
“The current diagnostic criteria for MS, the McDonald 2010 criteria, are shown in Panel 1.”
The paper relies on this without support.
The diagnosis of MS requires objective evidence of CNS lesions disseminated in time and space.
“The diagnosis of MS requires objective evidence of CNS lesions disseminated in time and space.”
The paper relies on this without support.
The diagnosis of MS and its many differential diagnoses can still be challenging.
“The diagnosis of MS and its many differential diagnoses can still be challenging but progress continues to be made.”
The paper relies on this without support.
Diagnostic criteria for both MS and NMOSD have changed in recent years as new pathological, immunological, imaging, clinical and therapeutic findings have emerged.
“Diagnostic criteria for both MS and NMOSD have changed in recent years as new pathological, immunological, imaging, clinical and therapeutic findings have emerged.”
Citations
Cites
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Self-citationIs late-onset multiple sclerosis associated with a worse outcome?
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Metadata
- Authors
- Brownlee, W. J., Hardy, T. A., Fazekas, F., & Miller, D. H.
- Affiliations
- National Hospital for Neurology and Neurosurgery (GB)
- The University of Sydney (AU)
- Medical University of Graz (AT)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Brownlee, Wallace J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 389
- Issue
- 10076
- Pages
- 1336-1346
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2553410079
- Semantic Scholar
- c3c940057822532b6a11789306c1f5e70c007e0e
- Cited by
- 701
- References
- 81
- Citations by year
- 2026: 53 · 2025: 73 · 2024: 79 · 2023: 101 · 2022: 73 · 2021: 93 · 2020: 88 · 2019: 68 · 2018: 52 · 2017: 20
- FWCI
- 36.44
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0508-10058)
- Multiple Sclerosis Society
- University College London Hospitals NHS Foundation Trust
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- multiple sclerosis, diagnosis, diagnostic criteria, magnetic resonance imaging, cerebrospinal fluid analysis, neurophysiological assessment, demyelination, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, differential diagnosis, misdiagnosis, serological testing, genetic testing, cerebral small vessel disease
- MeSH terms
- Brain, Diagnosis, Differential, Encephalomyelitis, Acute Disseminated, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Neuromyelitis Optica, Spinal Cord, Multiple Sclerosis, Relapsing-Remitting
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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