The spectrum of multiple sclerosis misdiagnosis in the era of McDonald criteria: A multicenter study (PL01.003)

Abstract

Objective: To characterize patients misdiagnosed with multiple sclerosis (MS) and hypothesize common causes for misdiagnosis. Background: Misdiagnosis of MS is a persistent if not growing problem despite, and perhaps because of, improved radiographic diagnostic techniques. Few studies have characterized the contemporary spectrum of MS misdiagnosis. Methods: Over 13 months, neurologists at four academic MS Centers submitted data concerning individual patients whom they had evaluated and determined to have been misdiagnosed with MS. Results: Of 110 misdiagnosed patients, 51 (46[percnt]) had “definite” and 59 (54[percnt]) “probable” misdiagnoses according to study definitions. The most frequent primary diagnoses were migraine alone or in combination with other diagnoses 24 (21[percnt]), fibromyalgia 16 (15[percnt]), nonspecific or non-localizing neurological symptoms with abnormal MRI 13 (12[percnt]), and conversion or psychogenic disorder 12 (11[percnt]). 27 additional diagnoses were reported. 32 (29[percnt]) of patients carried a misdiagnosis between 3-9 years and 29 (26[percnt]) for 10-20 years. 77 (70[percnt]) had taken disease modifying therapy, including natalizumab 14 (13[percnt]), mitoxantrone 2 (2[percnt]), cyclophosphamide 1 (1[percnt]). Four (4[percnt]) had participated in a research study of an MS therapy. In 79 (72[percnt]) of patients, participating neurologists indicated that there was evidence an earlier missed opportunity to make a correct diagnosis and 34 (31[percnt]) suffered unnecessary morbidity as a direct result of a misdiagnosis. Inappropriate attribution of symptoms to demyelinating disease contributed to misdiagnosis in 72 (65[percnt]) patients, and reliance upon historical symptoms without corroborating objective evidence of a lesion in 53 (48[percnt]). Over-reliance on MRI abnormalities to satisfy dissemination in space in a patient with nonspecific neurological symptoms contributed to misdiagnosis in 66 (60[percnt]). Conclusions: Misdiagnosis of MS is a common problem that may lead to treatment-related as well as psychosocial morbidity. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important causes of misdiagnosis.

Disclosure: Dr. Solomon has received personal compensation from Haymarket Media as a speaker. Dr. Bourdette has received personal compensation for activities with Biogen Idec, Serono, and Teva Neurosciences as a speaker/faculty. Dr. Cross has received personal compensation for activities with Biogen Idec, Genzyme Corporation, GlaxoSmithKline, Inc., Hoffman-La Roche, Teva Neuroscience, Novartis, and Questcor. Dr. Applebee has nothing to disclose. Dr. Skidd has nothing to disclose. Dr. Howard has nothing to disclose. Dr. Spain has nothing to disclose. Dr. Michelle Cameron has received compensation for activities with Acorda therapeutics, MD consult and ReWalk as a consultant. Dr. Kim has received personal compensation for activities with Teva pharmaceutical and Genzyme. Dr. Mass has nothing to disclose. Dr. Yadav has received personal compensation for activities with Novartis as a consultant. Dr. Yadav has received research support from Biogen Idec. Dr. Whitham has received personal compensation for activities with Chugai Pharmaceutical as a data safety monitoring board member. Dr. Longbrake has received personal compensation for activities with Genzyme. Dr. Naismith received personal compensation for activities with Alkermes, Acorda, Bayer, Biogen Idec, Genentech Inc., Genzyme Corporation, EMD Serono, Novartis, and Questcor as a consultant and from Acorda Therapeutics and Genzyme Corporation as a speaker Dr. Wu has received personal compensation for activities with Biogen Idec and Pfizer Inc. Dr. Parks has received personal compensation for activities with BiogenIdec and Novartis as an advisory board member. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Rabin has nothing to disclose. Dr. Toledano has nothing to disclose. Dr. Tobin has nothing to disclose. Dr. Kantarci has nothing to disclose. Dr. Carter has received personal compensation for activities with EMD-Serono, University of Louisville and Omnicare, Inc. for serving as a member of the board and various other activities. Dr. Carter has received research support from the Sanofi, Genzyme Dr. Keegan has received research support from Terumo BCT. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford