The contemporary spectrum of multiple sclerosis misdiagnosis

Andrew J. Solomon, Dennis N. Bourdette, Anne H. Cross, Angela Applebee, Philip M. Skidd, Diantha B. Howard, Rebecca I. Spain, Michelle H. Cameron, Edward Kim, Michele K. Mass, Vijayshree Yadav, Ruth H. Whitham, Erin E. Longbrake, Robert T. Naismith, Gregory F. Wu, Becky J. Parks, Dean Marko Wingerchuk, Brian L. Rabin, Michel Toledano, W. Oliver Tobin & 4 others Orhun H Kantarci, Jonathan L. Carter, B Mark Keegan, Brian G Weinshenker

Research output: Contribution to journalArticle

72 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1393-1399
Number of pages7
JournalNeurology
Volume87
Issue number13
DOIs
StatePublished - Sep 27 2016

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Diagnostic Errors
Multiple Sclerosis
Neurologic Manifestations
Neuromyelitis Optica
Fibromyalgia
Demyelinating Diseases
Migraine Disorders
Morbidity
Therapeutics
Research

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Solomon, A. J., Bourdette, D. N., Cross, A. H., Applebee, A., Skidd, P. M., Howard, D. B., ... Weinshenker, B. G. (2016). The contemporary spectrum of multiple sclerosis misdiagnosis. Neurology, 87(13), 1393-1399. https://doi.org/10.1212/WNL.0000000000003152

The contemporary spectrum of multiple sclerosis misdiagnosis. / 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 Marko; Rabin, Brian L.; Toledano, Michel; Tobin, W. Oliver; Kantarci, Orhun H; Carter, Jonathan L.; Keegan, B Mark; Weinshenker, Brian G.

In: Neurology, Vol. 87, No. 13, 27.09.2016, p. 1393-1399.

Research output: Contribution to journalArticle

Solomon, AJ, Bourdette, DN, Cross, AH, Applebee, A, Skidd, PM, Howard, DB, Spain, RI, Cameron, MH, Kim, E, Mass, MK, Yadav, V, Whitham, RH, Longbrake, EE, Naismith, RT, Wu, GF, Parks, BJ, Wingerchuk, DM, Rabin, BL, Toledano, M, Tobin, WO, Kantarci, OH, Carter, JL, Keegan, BM & Weinshenker, BG 2016, 'The contemporary spectrum of multiple sclerosis misdiagnosis', Neurology, vol. 87, no. 13, pp. 1393-1399. https://doi.org/10.1212/WNL.0000000000003152
Solomon AJ, Bourdette DN, Cross AH, Applebee A, Skidd PM, Howard DB et al. The contemporary spectrum of multiple sclerosis misdiagnosis. Neurology. 2016 Sep 27;87(13):1393-1399. https://doi.org/10.1212/WNL.0000000000003152
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 Marko ; Rabin, Brian L. ; Toledano, Michel ; Tobin, W. Oliver ; Kantarci, Orhun H ; Carter, Jonathan L. ; Keegan, B Mark ; Weinshenker, Brian G. / The contemporary spectrum of multiple sclerosis misdiagnosis. In: Neurology. 2016 ; Vol. 87, No. 13. pp. 1393-1399.
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AU - Solomon, Andrew J.

AU - Bourdette, Dennis N.

AU - Cross, Anne H.

AU - Applebee, Angela

AU - Skidd, Philip M.

AU - Howard, Diantha B.

AU - Spain, Rebecca I.

AU - Cameron, Michelle H.

AU - Kim, Edward

AU - Mass, Michele K.

AU - Yadav, Vijayshree

AU - Whitham, Ruth H.

AU - Longbrake, Erin E.

AU - Naismith, Robert T.

AU - Wu, Gregory F.

AU - Parks, Becky J.

AU - Wingerchuk, Dean Marko

AU - Rabin, Brian L.

AU - Toledano, Michel

AU - Tobin, W. Oliver

AU - Kantarci, Orhun H

AU - Carter, Jonathan L.

AU - Keegan, B Mark

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N2 - 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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