Highlights
- •Accurate multiple sclerosis diagnosis can be challenging.
- •18% of new MS patients in two clinics were determined to be misdiagnosed.
- •Misdiagnosis is associated with atypical clinical or imaging findings.
- •Misdiagnosed patients receive years of unnecessary MS medications.
- •Migraine is the most common alternate diagnosis.
Abstract
Background
Multiple Sclerosis (MS) specialists routinely evaluate misdiagnosed patients, or patients
incorrectly assigned a diagnosis of MS. Misdiagnosis has significant implications
for patient morbidity and healthcare costs, yet its contemporary incidence is unknown.
We examined the incidence of MS misdiagnosis in new patients referred to two academic
MS referral centers, their most common alternate diagnoses, and factors associated
with misdiagnosis.
Methods
Demographic data, comorbidities, neurological examination findings, radiographic and
laboratory results, a determination of 2010 McDonald Criteria fulfillment, and final
diagnoses were collected from all new patient evaluations completed at the Cedars-Sinai
Medical Center and the University of California, Los Angeles MS clinics over twelve
months.
Results
Of the 241 new patients referred with an established diagnosis of MS, 17% at Cedars-Sinai
and 19% at UCLA were identified as having been misdiagnosed. The most common alternative
diagnoses were migraine (16%), radiologically isolated syndrome (9%), spondylopathy
(7%), and neuropathy (7%). Clinical syndromes and radiographic findings atypical for
MS were both associated with misdiagnosis. The misdiagnosed group received approximately
110 patient-years of unnecessary MS disease modifying therapy.
Conclusion
MS misdiagnosis is common; in our combined cohort, almost 1 in 5 patients who carried
an established diagnosis of MS did not fulfill contemporary McDonald Criteria and
had a more likely alternate diagnosis.
Keywords
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Article info
Publication history
Published online: February 01, 2019
Accepted:
January 29,
2019
Received in revised form:
January 25,
2019
Received:
January 5,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
