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Multicenter Study
. 2016 Sep 27;87(13):1393-9.
doi: 10.1212/WNL.0000000000003152. Epub 2016 Aug 31.

The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study

Andrew J Solomon  1 , Dennis N Bourdette  2 , Anne H Cross  2 , Angela Applebee  2 , Philip M Skidd  2 , Diantha B Howard  2 , Rebecca I Spain  2 , Michelle H Cameron  2 , Edward Kim  2 , Michele K Mass  2 , Vijayshree Yadav  2 , Ruth H Whitham  2 , Erin E Longbrake  2 , Robert T Naismith  2 , Gregory F Wu  2 , Becky J Parks  2 , Dean M Wingerchuk  2 , Brian L Rabin  2 , Michel Toledano  2 , W Oliver Tobin  2 , Orhun H Kantarci  2 , Jonathan L Carter  2 , B Mark Keegan  2 , Brian G Weinshenker  2
Affiliations
Multicenter Study

The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study

Andrew J Solomon et al. Neurology. .

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.

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Figures

Figure 1
Figure 1. Duration of misdiagnosis
The number of years patients had been misdiagnosed with multiple sclerosis.
Figure 2
Figure 2. Cumulative exposure to immunomodulatory therapy
The cumulative number of years misdiagnosed patients had been exposed to any immunomodulatory therapy.
See this image and copyright information in PMC

Comment in

References

    1. Polman CH, Reingold SC, Banwell B, et al. . Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69:292–302. - PMC - PubMed
    1. Solomon AJ, Klein EP, Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology 2012;78:1986–1991. - PMC - PubMed
    1. Solomon AJ, Klein E. Disclosing a misdiagnosis of multiple sclerosis: do no harm? Continuum 2013;19:1087–1091. - PubMed
    1. Solomon AJ, Weinshenker BG. Misdiagnosis of multiple sclerosis: frequency, causes, effects, and prevention. Curr Neurol Neurosci Rep 2013;13:403. - PubMed
    1. Singh H, Graber ML. Improving diagnosis in health care: the next imperative for patient safety. N Engl J Med 2015;373:2493–2495. - PubMed

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