Differential diagnosis of suspected multiple sclerosis: considerations in people from minority ethnic and racial backgrounds in North America, northern Europe, and Australasia

Lilyana Amezcua; Dalia Rotstein; Afsaneh Shirani; Olga Ciccarelli; Daniel Ontaneda; Melinda Magyari; Victor Rivera; Dorlan Kimbrough; Ruth Dobson; Bruce Taylor; Mitzi Williams; Ruth Ann Marrie; Brenda Banwell; Bernhard Hemmer; Scott D Newsome; Jeffrey A Cohen; Andrew J Solomon; Walter Royal 3rd

doi:10.1016/S1474-4422(24)00288-6

Differential diagnosis of suspected multiple sclerosis: considerations in people from minority ethnic and racial backgrounds in North America, northern Europe, and Australasia

Lancet Neurol. 2024 Oct;23(10):1050-1062. doi: 10.1016/S1474-4422(24)00288-6.

Authors

Lilyana Amezcua¹, Dalia Rotstein², Afsaneh Shirani³, Olga Ciccarelli⁴, Daniel Ontaneda⁵, Melinda Magyari⁶, Victor Rivera⁷, Dorlan Kimbrough⁸, Ruth Dobson⁹, Bruce Taylor¹⁰, Mitzi Williams¹¹, Ruth Ann Marrie¹², Brenda Banwell¹³, Bernhard Hemmer¹⁴, Scott D Newsome¹⁵, Jeffrey A Cohen⁵, Andrew J Solomon¹⁶, Walter Royal 3rd¹⁷

Affiliations

¹ University of Southern California (USC), Keck School of Medicine, Department of Neurology, Los Angeles, CA, USA. Electronic address: [email protected].
² Division of Neurology, Department of Medicine, University of Toronto, ON, Canada; St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
³ Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
⁴ Queen Square MS Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK; National institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK.
⁵ Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
⁶ Danish Multiple Sclerosis Center and The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.
⁷ Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
⁸ Department of Neurology, Duke University Medical Center, Durham, NC, USA.
⁹ Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University, London, UK.
¹⁰ BVT Menzies Institute for Medical Research University of Tasmania, Hobart, TAS, Australia.
¹¹ Joi Life Wellness MS Center, Smyrna, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
¹² Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹³ Department of Neurology, University of Pennsylvania, Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Department of Neurology, Klinikum rechts der Isar, Medical Faculty, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany.
¹⁵ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁶ Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, University Health Center, Burlington, VT, USA.
¹⁷ Department of Neurobiology & Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA.

PMID: 39304244
DOI: 10.1016/S1474-4422(24)00288-6

Abstract

The differential diagnosis of suspected multiple sclerosis has been developed using data from North America, northern Europe, and Australasia, with a focus on White populations. People from minority ethnic and racial backgrounds in regions where prevalence of multiple sclerosis is high are more often negatively affected by social determinants of health, compared with White people in these regions. A better understanding of changing demographics, the clinical characteristics of people from minority ethnic or racial backgrounds, and the social challenges they face might facilitate equitable clinical approaches when considering a diagnosis of multiple sclerosis. Neuromyelitis optica, systemic lupus erythematous, neurosarcoidosis, infections, and cerebrovascular conditions (eg, hypertension) should be considered in the differential diagnosis of multiple sclerosis for people from minority ethnic and racial backgrounds in North America, northern Europe, and Australasia. The diagnosis of multiple sclerosis in people from a minority ethnic or racial background in these regions requires a comprehensive approach that considers the complex interplay of immigration, diagnostic inequity, and social determinants of health.

Publication types

Review

MeSH terms

Australasia / ethnology
Diagnosis, Differential
Ethnic and Racial Minorities
Ethnicity
Europe / ethnology
Humans
Multiple Sclerosis* / diagnosis
Multiple Sclerosis* / ethnology
North America / ethnology