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. 2022 Jul;28(8):1248-1256.
doi: 10.1177/13524585211048401. Epub 2021 Oct 6.

Multiple sclerosis diagnosis: Knowledge gaps and opportunities for educational intervention in neurologists in the United States

Andrew J Solomon  1 , Marwa Kaisey  2 , Stephen C Krieger  3 , Salim Chahin  4 , Robert T Naismith  4 , Sarah M Weinstein  5 , Russell T Shinohara  5 , Brian G Weinshenker  6
Affiliations

Multiple sclerosis diagnosis: Knowledge gaps and opportunities for educational intervention in neurologists in the United States

Andrew J Solomon et al. Mult Scler. 2022 Jul.

Abstract

Background: Few studies have addressed the results of educational efforts concerning proper use of McDonald criteria (MC) revisions outside multiple sclerosis (MS) subspecialty centers. Neurology residents and MS subspecialist neurologists demonstrated knowledge gaps for core elements of the MC in a recent prior study.

Objective: To assess comprehension and application of MC core elements by non-MS specialist neurologists in the United States who routinely diagnose MS.

Methods: Through a cross-sectional study design, a previously developed survey instrument was distributed online.

Results: A total of 222 neurologists completed the study survey. Syndromes atypical for MS were frequently incorrectly considered "typical" MS presentations. Fourteen percent correctly identified definitions of both "periventricular" and "juxtacortical" lesions and 2% correctly applied these terms to 9/9 images. Twenty-four percent correctly identified all four central nervous system (CNS) regions for satisfaction of magnetic resonance imaging (MRI) dissemination in space. In two presented cases, 61% and 71% correctly identified dissemination in time (DIT) was not fulfilled, and 85% and 86% subsequently accepted nonspecific historical symptoms without objective evidence for DIT fulfillment.

Conclusion: The high rate of knowledge deficiencies and application errors of core elements of the MC demonstrated by participants in this study raise pressing questions concerning adequacy of dissemination and educational efforts upon publication of revisions to MC.

Keywords: Demyelinating disease (CNS); diagnosis; diagnostic criteria; education; multiple sclerosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: A.J.S. has consulted for EMS Serono, Genentech, Biogen, Alexion, Celgene, and Greenwich Biosciences. S.C. has received consulting and/or speaking fees from Biogen, Genentech, Genzyme, and Novartis. M.K. has received honoraria for speaking engagements from Alexion, Biogen, Genentech, and Viela Bio. S.C.K. reports consulting or advisory work with Biogen, EMD Serono, Genentech, Genzyme, Mallinckrodt, MedDay, Novartis, Octave, Teva, and TG Therapeutics, and non-promotional speaking with Biogen, EMD Serono, Genentech, and Novartis. Grant and research support from Biogen and Novartis. R.T.N. has consulted for Biogen, Bristol Myers Squibb, Genentech, Genzyme, GW Therapeutics, Janssen, Lundbeck, Nervgen, Third Rock Ventures, TG Therapeutics, and Viela Bio. S.M.W. reports no conflicts. R.T.S. reports consulting income from Octave Bioscience. I also receive compensation for reviewing scientific articles from the American Medical Association and for reviewing grants for the Emerson Collective, National Institutes of Health, and the Department of Defense. B.G.W. receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for neuromyelitis optica spectrum disorders, served on adjudication committee for clinical trials in neuromyelitis optica spectrum disorders being conducted by MedImmune/VielaBio, Alexion, UCB Biosciences and consulted for Chugai/Roche/Genentech and Mitsubishi-Tanabe regarding a clinical trial for neuromyelitis optica spectrum disorders. He has received honoraria for speaking at internal meetings of Genentech, Novartis, and external meetings for Roche.

Figures

Figure 1.
Figure 1.
Six examples of study survey images that evaluated participant knowledge for periventricular and juxtacortical lesion location. Correct responses for number of periventricular lesions: a: 1, b: 1, e: 1. Correct responses for number of juxtacortical lesions: a: 0, c: 1, d: 1, f: 0.
See this image and copyright information in PMC

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