Re:The problem of Misdiagnosis: Ongoing problem even if you make the correct initial diagnosis
IsraelSteiner, Neurologist, Department of Neurology, Rabin Medical Center, Petach Tikva, Israelisteiner@cc.huji.ac.il
Submitted July 25, 2012
I read with the editorial and two studies related to the misdiagnosis of MS. [1-3] Unfortunately, all of these articles fail to address three important aspects partially responsible for the difficulty in making the diagnosis of MS and for the increasing rate of incorrect diagnosis that is larger than in other fields of neurology.
Firstly, MS is a syndrome, not a uniform homogeneous disease. [4] Secondly, the revised diagnostic criteria of the last 12 years and their modifications rely more on imaging. As a result, the diagnostic umbrella has been opened to include other conditions such as vasculitis, Susac syndrome, and Behcet disease. This heightens the margin of error. Finally, there is a tremendous economical benefit to the pharmacological industry to make the diagnosis of MS in an individual patient and increasing pressure from biopharma to recruit patients into clinical studies.
Misdiagnosis in MS is a symptom of a much larger problem. Since we do not know the underlying etiology and pathogenesis of the condition, [6] and have no surrogate diagnostic marker, we are destined to err in diagnosis. There is also the danger of enlisting misdiagnosed patients into clinical trials, which results in an inability to truly study the cause of the disease. In addition, we may be providing unsafe therapies to these patients.
1. Boissy AR, Ford PJ. A touch of MS: Therapeutic mislabeling. Neurology.
2012;78:1981-5
2. Solomon AJ, Klein EP, Bourdette D. "Undignosing" multiple sclerosis:
The challenge of misdiagnosis in MS. Neurology. 2012;78:1986-1991
3. Rudick RA, Miller AE. Multiple sclerosis or multiple possibilities: The
continuing problem of misdiagnosis. Neurology. 2012;78:1904-1906.
4. Sriram S, Steiner I. Experimental allergic encephalomyelitis: a
misleading model of multiple sclerosis. Ann Neurol. 2005;58:939-945.
5. Steiner I. On human disease and animal models. Ann Neurol. 2011;70:343-344.
For disclosures, contact the editorial office at journal@neurology.org.
I read with the editorial and two studies related to the misdiagnosis of MS. [1-3] Unfortunately, all of these articles fail to address three important aspects partially responsible for the difficulty in making the diagnosis of MS and for the increasing rate of incorrect diagnosis that is larger than in other fields of neurology.
Firstly, MS is a syndrome, not a uniform homogeneous disease. [4] Secondly, the revised diagnostic criteria of the last 12 years and their modifications rely more on imaging. As a result, the diagnostic umbrella has been opened to include other conditions such as vasculitis, Susac syndrome, and Behcet disease. This heightens the margin of error. Finally, there is a tremendous economical benefit to the pharmacological industry to make the diagnosis of MS in an individual patient and increasing pressure from biopharma to recruit patients into clinical studies.
Misdiagnosis in MS is a symptom of a much larger problem. Since we do not know the underlying etiology and pathogenesis of the condition, [6] and have no surrogate diagnostic marker, we are destined to err in diagnosis. There is also the danger of enlisting misdiagnosed patients into clinical trials, which results in an inability to truly study the cause of the disease. In addition, we may be providing unsafe therapies to these patients.
1. Boissy AR, Ford PJ. A touch of MS: Therapeutic mislabeling. Neurology. 2012;78:1981-5
2. Solomon AJ, Klein EP, Bourdette D. "Undignosing" multiple sclerosis: The challenge of misdiagnosis in MS. Neurology. 2012;78:1986-1991
3. Rudick RA, Miller AE. Multiple sclerosis or multiple possibilities: The continuing problem of misdiagnosis. Neurology. 2012;78:1904-1906.
4. Sriram S, Steiner I. Experimental allergic encephalomyelitis: a misleading model of multiple sclerosis. Ann Neurol. 2005;58:939-945.
5. Steiner I. On human disease and animal models. Ann Neurol. 2011;70:343-344.
For disclosures, contact the editorial office at journal@neurology.org.