The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. (27th September 2016)

• Record Type: Journal Article
• Authors: Solomon, Andrew J.; Bourdette, Dennis N.; Cross, Anne H.; Applebee, Angela; Skidd, Philip M.; Howard, Diantha B.; Spain, Rebecca I.; Cameron, Michelle H.; Kim, Edward; Mass, Michele K.; Yadav, Vijayshree; Whitham, Ruth H.; Longbrake, Erin E.; Naismith, Robert T.; Wu, Gregory F.; Parks, Becky J.; Wingerchuk, Dean M.; Rabin, Brian L.; Toledano, Michel; Tobin, W. Oliver; Kantarci, Orhun H.; Carter, Jonathan L.; Keegan, B. Mark; Weinshenker, Brian G.
• Is Part Of: Neurology. Volume 86:Number 13(2016)
• Publication Date: 2016-09-27
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000003152
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To characterize patients misdiagnosed with multiple sclerosis (MS). Methods: Neurologists at 4 academic MS centers submitted data on patients determined to have been misdiagnosed with MS. Results: Of 110 misdiagnosed patients, 51 (46%) were classified as "definite" and 59 (54%) "probable" misdiagnoses according to study definitions. Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%). Duration of misdiagnosis was 10 years or longer in 36 (33%) and an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%). Seventy-seven (70%) received disease-modifying therapy and 34 (31%) experienced unnecessary morbidity because of misdiagnosis. Four (4%) participated in a research study of an MS therapy. Leading factors contributing to misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms. Conclusions: Misdiagnosis of MS leads to unnecessary and potentially harmful risks to patients. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important contemporary contributors to misdiagnosis.