The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study
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” mi...
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| Veröffentlicht in: | Neurology 2016-09, Vol.87 (13), p.1393-1399 |
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| creator | 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 M Rabin, Brian L Toledano, Michel Tobin, W Oliver Kantarci, Orhun H Carter, Jonathan L Keegan, B Mark Weinshenker, Brian G |
| description | 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. |
| doi_str_mv | 10.1212/WNL.0000000000003152 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5047038</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1877811710</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3232-8f32a657363267dc5d00998e1f44feca5fe926bab49756c18a57e6a2314c2bbc3</originalsourceid><addsrcrecordid>eNqNkUtLxDAUhYMozvj4ByJduqnm0TapC2EQXzAogqK7kKa3M9V0UpNWmX9vhhlldCFmkRDuuR_n3oPQAcHHhBJ68nQ7PsZrh5GUbqBhuLM4Y_R5Ew0xpiJmgosB2vH-BeNQ5Pk2GlCeigDhQ3T_MIVI21kHTWudcvPIt6A71zeRraKmN13dGoi8NuCsr33U1L6s1WS2-JxGo6VEQwC4yHd9Od9DW5UyHvZX7y56vLx4OL-Ox3dXN-ejcawZZTQWFaMqSzkLXjNe6rTEOM8FkCpJKtAqrSCnWaGKJOdppolQKYdMUUYSTYtCs110tuS2fdFAubDglJGtq5swhrSqlj8rs3oqJ_ZdpjjhmIkAOFoBnH3rwXcyzKbBGDUD23tJBOeCEE7wP6Q0oZRjToM0WUp12Jd3UH07IlgugpMhOPk7uNB2uD7Nd9NXUkEgloIPa8Ku_avpP8DJKSjTTf9mfwJr0qZu</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1824227072</pqid></control><display><type>article</type><title>The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>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 M ; Rabin, Brian L ; Toledano, Michel ; Tobin, W Oliver ; Kantarci, Orhun H ; Carter, Jonathan L ; Keegan, B Mark ; Weinshenker, Brian G</creator><creatorcontrib>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 M ; Rabin, Brian L ; Toledano, Michel ; Tobin, W Oliver ; Kantarci, Orhun H ; Carter, Jonathan L ; Keegan, B Mark ; Weinshenker, Brian G</creatorcontrib><description>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.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000003152</identifier><identifier>PMID: 27581217</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Academic Medical Centers ; Biomarkers - cerebrospinal fluid ; Clinical Trials as Topic ; Contemporary Issues ; Diagnostic Errors ; Female ; Humans ; Immunomodulation ; Male ; Middle Aged ; Multiple Sclerosis - diagnosis ; Multiple Sclerosis - therapy ; United States</subject><ispartof>Neurology, 2016-09, Vol.87 (13), p.1393-1399</ispartof><rights>2016 American Academy of Neurology</rights><rights>2016 American Academy of Neurology.</rights><rights>2016 American Academy of Neurology 2016 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3232-8f32a657363267dc5d00998e1f44feca5fe926bab49756c18a57e6a2314c2bbc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27581217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Solomon, Andrew J</creatorcontrib><creatorcontrib>Bourdette, Dennis N</creatorcontrib><creatorcontrib>Cross, Anne H</creatorcontrib><creatorcontrib>Applebee, Angela</creatorcontrib><creatorcontrib>Skidd, Philip M</creatorcontrib><creatorcontrib>Howard, Diantha B</creatorcontrib><creatorcontrib>Spain, Rebecca I</creatorcontrib><creatorcontrib>Cameron, Michelle H</creatorcontrib><creatorcontrib>Kim, Edward</creatorcontrib><creatorcontrib>Mass, Michele K</creatorcontrib><creatorcontrib>Yadav, Vijayshree</creatorcontrib><creatorcontrib>Whitham, Ruth H</creatorcontrib><creatorcontrib>Longbrake, Erin E</creatorcontrib><creatorcontrib>Naismith, Robert T</creatorcontrib><creatorcontrib>Wu, Gregory F</creatorcontrib><creatorcontrib>Parks, Becky J</creatorcontrib><creatorcontrib>Wingerchuk, Dean M</creatorcontrib><creatorcontrib>Rabin, Brian L</creatorcontrib><creatorcontrib>Toledano, Michel</creatorcontrib><creatorcontrib>Tobin, W Oliver</creatorcontrib><creatorcontrib>Kantarci, Orhun H</creatorcontrib><creatorcontrib>Carter, Jonathan L</creatorcontrib><creatorcontrib>Keegan, B Mark</creatorcontrib><creatorcontrib>Weinshenker, Brian G</creatorcontrib><title>The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study</title><title>Neurology</title><addtitle>Neurology</addtitle><description>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.</description><subject>Academic Medical Centers</subject><subject>Biomarkers - cerebrospinal fluid</subject><subject>Clinical Trials as Topic</subject><subject>Contemporary Issues</subject><subject>Diagnostic Errors</subject><subject>Female</subject><subject>Humans</subject><subject>Immunomodulation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multiple Sclerosis - diagnosis</subject><subject>Multiple Sclerosis - therapy</subject><subject>United States</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUtLxDAUhYMozvj4ByJduqnm0TapC2EQXzAogqK7kKa3M9V0UpNWmX9vhhlldCFmkRDuuR_n3oPQAcHHhBJ68nQ7PsZrh5GUbqBhuLM4Y_R5Ew0xpiJmgosB2vH-BeNQ5Pk2GlCeigDhQ3T_MIVI21kHTWudcvPIt6A71zeRraKmN13dGoi8NuCsr33U1L6s1WS2-JxGo6VEQwC4yHd9Od9DW5UyHvZX7y56vLx4OL-Ox3dXN-ejcawZZTQWFaMqSzkLXjNe6rTEOM8FkCpJKtAqrSCnWaGKJOdppolQKYdMUUYSTYtCs110tuS2fdFAubDglJGtq5swhrSqlj8rs3oqJ_ZdpjjhmIkAOFoBnH3rwXcyzKbBGDUD23tJBOeCEE7wP6Q0oZRjToM0WUp12Jd3UH07IlgugpMhOPk7uNB2uD7Nd9NXUkEgloIPa8Ku_avpP8DJKSjTTf9mfwJr0qZu</recordid><startdate>20160927</startdate><enddate>20160927</enddate><creator>Solomon, Andrew J</creator><creator>Bourdette, Dennis N</creator><creator>Cross, Anne H</creator><creator>Applebee, Angela</creator><creator>Skidd, Philip M</creator><creator>Howard, Diantha B</creator><creator>Spain, Rebecca I</creator><creator>Cameron, Michelle H</creator><creator>Kim, Edward</creator><creator>Mass, Michele K</creator><creator>Yadav, Vijayshree</creator><creator>Whitham, Ruth H</creator><creator>Longbrake, Erin E</creator><creator>Naismith, Robert T</creator><creator>Wu, Gregory F</creator><creator>Parks, Becky J</creator><creator>Wingerchuk, Dean M</creator><creator>Rabin, Brian L</creator><creator>Toledano, Michel</creator><creator>Tobin, W Oliver</creator><creator>Kantarci, Orhun H</creator><creator>Carter, Jonathan L</creator><creator>Keegan, B Mark</creator><creator>Weinshenker, Brian G</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope><scope>5PM</scope></search><sort><creationdate>20160927</creationdate><title>The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study</title><author>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 M ; Rabin, Brian L ; Toledano, Michel ; Tobin, W Oliver ; Kantarci, Orhun H ; Carter, Jonathan L ; Keegan, B Mark ; Weinshenker, Brian G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3232-8f32a657363267dc5d00998e1f44feca5fe926bab49756c18a57e6a2314c2bbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Academic Medical Centers</topic><topic>Biomarkers - cerebrospinal fluid</topic><topic>Clinical Trials as Topic</topic><topic>Contemporary Issues</topic><topic>Diagnostic Errors</topic><topic>Female</topic><topic>Humans</topic><topic>Immunomodulation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multiple Sclerosis - diagnosis</topic><topic>Multiple Sclerosis - therapy</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Solomon, Andrew J</creatorcontrib><creatorcontrib>Bourdette, Dennis N</creatorcontrib><creatorcontrib>Cross, Anne H</creatorcontrib><creatorcontrib>Applebee, Angela</creatorcontrib><creatorcontrib>Skidd, Philip M</creatorcontrib><creatorcontrib>Howard, Diantha B</creatorcontrib><creatorcontrib>Spain, Rebecca I</creatorcontrib><creatorcontrib>Cameron, Michelle H</creatorcontrib><creatorcontrib>Kim, Edward</creatorcontrib><creatorcontrib>Mass, Michele K</creatorcontrib><creatorcontrib>Yadav, Vijayshree</creatorcontrib><creatorcontrib>Whitham, Ruth H</creatorcontrib><creatorcontrib>Longbrake, Erin E</creatorcontrib><creatorcontrib>Naismith, Robert T</creatorcontrib><creatorcontrib>Wu, Gregory F</creatorcontrib><creatorcontrib>Parks, Becky J</creatorcontrib><creatorcontrib>Wingerchuk, Dean M</creatorcontrib><creatorcontrib>Rabin, Brian L</creatorcontrib><creatorcontrib>Toledano, Michel</creatorcontrib><creatorcontrib>Tobin, W Oliver</creatorcontrib><creatorcontrib>Kantarci, Orhun H</creatorcontrib><creatorcontrib>Carter, Jonathan L</creatorcontrib><creatorcontrib>Keegan, B Mark</creatorcontrib><creatorcontrib>Weinshenker, Brian G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Solomon, Andrew J</au><au>Bourdette, Dennis N</au><au>Cross, Anne H</au><au>Applebee, Angela</au><au>Skidd, Philip M</au><au>Howard, Diantha B</au><au>Spain, Rebecca I</au><au>Cameron, Michelle H</au><au>Kim, Edward</au><au>Mass, Michele K</au><au>Yadav, Vijayshree</au><au>Whitham, Ruth H</au><au>Longbrake, Erin E</au><au>Naismith, Robert T</au><au>Wu, Gregory F</au><au>Parks, Becky J</au><au>Wingerchuk, Dean M</au><au>Rabin, Brian L</au><au>Toledano, Michel</au><au>Tobin, W Oliver</au><au>Kantarci, Orhun H</au><au>Carter, Jonathan L</au><au>Keegan, B Mark</au><au>Weinshenker, Brian G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2016-09-27</date><risdate>2016</risdate><volume>87</volume><issue>13</issue><spage>1393</spage><epage>1399</epage><pages>1393-1399</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><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.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>27581217</pmid><doi>10.1212/WNL.0000000000003152</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Academic Medical Centers Biomarkers - cerebrospinal fluid Clinical Trials as Topic Contemporary Issues Diagnostic Errors Female Humans Immunomodulation Male Middle Aged Multiple Sclerosis - diagnosis Multiple Sclerosis - therapy United States |
| title | The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study |
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