Multiple biomarkers improve the prediction of MS in patients with a first demyelinating event
GloriaDalla Costa, MD, San Raffaele Hospital, Milan, Italydallacosta.gloria@hsr.it
Vittorio Martinelli, Giancarlo Comi, San Raffaele Hospital, Milan, Italy
Submitted November 17, 2016
We read with interest the multicenter observational study by Solomon et al. which assessed the prevalence and possible causes of multiple sclerosis (MS) misdiagnosis. [1] We are concerned about the interpretation of the results and the assertion of the conclusion that misinterpretation and misapplication of MS criteria are significant contemporary contributors to misdiagnosis.
In the study, patients previously informed of a MS diagnosis were included, [1] but the number of patients screened, the baseline clinical and paraclinical characteristics of the misdiagnosed patients, and the fulfilled MS criteria through which the diagnosis was made were not specified. Therefore, the frequency of MS misdiagnosis is not clear, including whether clinical practice misdiagnosis is mainly caused by misapplication of criteria due to lack of a comprehensive work-up excluding different diagnoses, or to poor performance of the MS criteria in atypical forms of MS. [2] In any case, Solomon et al. must be acknowledged for great efforts in recruiting a large population of misdiagnosed patients, highlighting the importance of a comprehensive clinical and paraclinical assessment for risk stratification of the patient, and a more accurate and personalized risk management of MS.
1. Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. Neurology 2016;87:1393-1399.
2. Kim SS, Richman DP, Johnson WO, Hald JK, Agius MA. Limited utility of current MRI criteria for distinguishing multiple sclerosis from common mimickers: primary and secondary CNS vasculitis, lupus and Sjogren's syndrome. Mult Scler 2014;20:57-63.
For disclosures, please contact the editorial office at journal@neurology.org.
We read with interest the multicenter observational study by Solomon et al. which assessed the prevalence and possible causes of multiple sclerosis (MS) misdiagnosis. [1] We are concerned about the interpretation of the results and the assertion of the conclusion that misinterpretation and misapplication of MS criteria are significant contemporary contributors to misdiagnosis.
In the study, patients previously informed of a MS diagnosis were included, [1] but the number of patients screened, the baseline clinical and paraclinical characteristics of the misdiagnosed patients, and the fulfilled MS criteria through which the diagnosis was made were not specified. Therefore, the frequency of MS misdiagnosis is not clear, including whether clinical practice misdiagnosis is mainly caused by misapplication of criteria due to lack of a comprehensive work-up excluding different diagnoses, or to poor performance of the MS criteria in atypical forms of MS. [2] In any case, Solomon et al. must be acknowledged for great efforts in recruiting a large population of misdiagnosed patients, highlighting the importance of a comprehensive clinical and paraclinical assessment for risk stratification of the patient, and a more accurate and personalized risk management of MS.
1. Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. Neurology 2016;87:1393-1399.
2. Kim SS, Richman DP, Johnson WO, Hald JK, Agius MA. Limited utility of current MRI criteria for distinguishing multiple sclerosis from common mimickers: primary and secondary CNS vasculitis, lupus and Sjogren's syndrome. Mult Scler 2014;20:57-63.
For disclosures, please contact the editorial office at journal@neurology.org.