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Meta-Analysis
. 2024 Oct;30(11-12):1409-1422.
doi: 10.1177/13524585241274527. Epub 2024 Sep 8.

Misdiagnosis and underdiagnosis of multiple sclerosis: A systematic review and meta-analysis

Wolfgang Emanuel Zürrer  1   2 , Amelia Elaine Cannon  1   2 , Dariya Ilchenko  1   2 , María Inés Gaitán  3 , Tobias Granberg  4   5 , Fredrik Piehl  5   6 , Andrew J Solomon  7 , Benjamin Victor Ineichen  1   2
Affiliations
Meta-Analysis

Misdiagnosis and underdiagnosis of multiple sclerosis: A systematic review and meta-analysis

Wolfgang Emanuel Zürrer et al. Mult Scler. 2024 Oct.

Abstract

Background: Diagnostic errors in multiple sclerosis (MS) impact patients and healthcare systems.

Objectives: This study aimed to determine the prevalence of MS misdiagnosis and underdiagnosis, time delay in reaching a correct diagnosis and potential impact of sex.

Methods: Systematic review and meta-analysis on MS diagnostic errors.

Results: Out of 3910 studies, we included 62 for a qualitative synthesis and 24 for meta-analyses. Frequency of misdiagnosis (incorrect assignment of an MS diagnosis) ranged from 5% to 41%, with a pooled proportion based on six studies of 15% (95% CI: 9%-26%, n = 1621). The delay to rectify a misdiagnosis ranged from 0.3 to 15.9 years. Conversely, underdiagnosis (unrecognized diagnosis of MS) ranged from 3% to 58%, with a pooled proportion in four studies of 36% (95% CI: 20%-55%, n = 728). Pooling seven studies comprising 2851 individuals suggested a diagnostic delay to establish a correct MS diagnosis of 17.3 months (95% CI: 11.9-22.7) in patients underdiagnosed. In a meta-analysis of five studies, women were 2.1 times more likely to be misdiagnosed with MS compared to men (odds ratio, 95% CI: 1.53-2.86).

Conclusion: This study provides summary-level evidence for the high prevalence of MS misdiagnosis and underdiagnosis. Future studies are needed to understand the causes of these diagnostic challenges in MS care.

Keywords: Multiple sclerosis; diagnostic delay; diagnostic error; meta-analysis; misdiagnosis; systematic review; underdiagnosis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: F.P. declares research grants outside of this study from Janssen, Merck KGaA and UCB, and fees for serving on Data Monitoring Committee in clinical trials with Chugai, Lundbeck and Roche and expert testimony for Novartis. A.J.S. declares consulting for Octave Bioscience, TG Therapeutics and Kiniksa Pharmaceuticals; served on advisory board for Genentech, Horizon Therapeutics; provided non-promotional Speaking for EMD Serono; site PI for contract research for Sanofi, Actelion, Genentech/Roche and Novartis; received research funding from Bristol Myers Squibb. B.V.I. declares non-promotional Speaking for CSL Behring. The other authors declare no conflicts of interest.

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