The diagnosis is clinical and depends on the following determinants:

• Lesions are invariably UMN.

• Lesions affect the CNS white matter.

• >1 part of CNS is involved, although not necessarily at time of presentation.

• Episodes are separated in time (it is possible to make a diagnosis with the first episode).

Other neurological diseases such as infections (e.g. encephalitis), malignancies, spinal cord compression, spinocerebellar degeneration and others must be excluded.

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