Contributions
Abstract: P799
Type: Poster
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Objectives: The McDonald criteria emphasize the importance of excluding other diseases or mimickers before a final diagnosis is made. The aim of this study is to explore the frequency, type, and predictors of MS mimickers among cases referred to two specialized MS centers in the Middle East with a recent diagnosis of MS.
Methods: This is a retrospective review of a prospectively followed cohort of MS patients at 2 University specialized MS centers in Lebanon and Kuwait. We included all patients presenting for the first time to the MS Centers in Lebanon between 2012 and 2015 and in Kuwait between 2015 and March 2016. The final diagnosis was recorded and demographic, clinical, laboratory, electrophysiological and radiological variables were collected. Cases of CIS highly suggestive of MS (n=19) were lumped with MS patients for the purpose of this analysis.
Results: 554 patients were included in this study of which 431 were referred for diagnostic confirmation of MS. Of those 431 patients, the final diagnosis of MS was confirmed in 300 (69.6%) patients, while 116 (26.9%) turned out to have an alternative diagnosis and 15 fulfilled the criteria for radiologically isolated syndrome (RIS). Of 179 patients referred for a clinical suspicion of MS, 94 (52.5%) had MS, 81(45.3%) an alternative diagnosis and 2 (1.1%) RIS. Of 37 patients referred for radiological suspicion of MS, 3(8.1%) had MS, 22 (59.5%) an alternative diagnosis and 12 (32.4%) RIS. The most common alternative diagnoses were psychogenic (16.3%), non-specific MRI white matter lesions (14.7%), NMO (9.5%), migraine (8.6%) and systemic autoimmune disorders (8.6%). The strongest predictors of an alternative diagnosis were: older age, cognitive presenting symptoms, isolated MRI findings, MRI findings not fulfilling 2010 McDonald criteria for dissemination in time or space, absence of oligoclonal bands in the CSF, normal neurological examination (P< 0.0001), and normal visual evoked potentials (P=0.002). A detailed multivariate analysis of the predictors will be presented.
Conclusions: Our study shows that 30% of patients referred to a specialized MS center end up with a different diagnosis. The most common mimickers of MS in the Middle East are not different from what has been described in the West. Neurological signs and symptoms, age, and laboratory and radiological findings can help with the differential diagnosis.
Disclosure: Authors have nothing to disclose in reference to this work
Abstract: P799
Type: Poster
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Objectives: The McDonald criteria emphasize the importance of excluding other diseases or mimickers before a final diagnosis is made. The aim of this study is to explore the frequency, type, and predictors of MS mimickers among cases referred to two specialized MS centers in the Middle East with a recent diagnosis of MS.
Methods: This is a retrospective review of a prospectively followed cohort of MS patients at 2 University specialized MS centers in Lebanon and Kuwait. We included all patients presenting for the first time to the MS Centers in Lebanon between 2012 and 2015 and in Kuwait between 2015 and March 2016. The final diagnosis was recorded and demographic, clinical, laboratory, electrophysiological and radiological variables were collected. Cases of CIS highly suggestive of MS (n=19) were lumped with MS patients for the purpose of this analysis.
Results: 554 patients were included in this study of which 431 were referred for diagnostic confirmation of MS. Of those 431 patients, the final diagnosis of MS was confirmed in 300 (69.6%) patients, while 116 (26.9%) turned out to have an alternative diagnosis and 15 fulfilled the criteria for radiologically isolated syndrome (RIS). Of 179 patients referred for a clinical suspicion of MS, 94 (52.5%) had MS, 81(45.3%) an alternative diagnosis and 2 (1.1%) RIS. Of 37 patients referred for radiological suspicion of MS, 3(8.1%) had MS, 22 (59.5%) an alternative diagnosis and 12 (32.4%) RIS. The most common alternative diagnoses were psychogenic (16.3%), non-specific MRI white matter lesions (14.7%), NMO (9.5%), migraine (8.6%) and systemic autoimmune disorders (8.6%). The strongest predictors of an alternative diagnosis were: older age, cognitive presenting symptoms, isolated MRI findings, MRI findings not fulfilling 2010 McDonald criteria for dissemination in time or space, absence of oligoclonal bands in the CSF, normal neurological examination (P< 0.0001), and normal visual evoked potentials (P=0.002). A detailed multivariate analysis of the predictors will be presented.
Conclusions: Our study shows that 30% of patients referred to a specialized MS center end up with a different diagnosis. The most common mimickers of MS in the Middle East are not different from what has been described in the West. Neurological signs and symptoms, age, and laboratory and radiological findings can help with the differential diagnosis.
Disclosure: Authors have nothing to disclose in reference to this work