Contributions
Abstract: EP1294
Type: ePoster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: Diagnosing multiple sclerosis involves evaluation of the patient history, examination, imaging, and ancillary testing. No one test can rule in nor rule out MS, and many diseases can mimic the often vague symptoms of MS or cause white matter lesions in the central nervous system. While specific diagnostic criteria exist with revisions under review, there is still room for error in this process. A survey of MS specialists found that 94% had evaluated at least one patient in the last year who had an incorrect diagnosis of MS. Studies of groups of misdiagnosed patients found migraine and psychiatric disease to be the most common correct diagnoses. We evaluated the referrals to our sub-specialty multiple sclerosis clinic in an effort to understand the types of and reasons for these errors.
Objectives: To identify the incidence of misdiagnosis of MS and any patterns or common mistakes that lead to these errors.
Methods: All new consults seen in an MS clinic from July 2016 - May 2017 were evaluated and categorized by initial diagnosis on referral, category of disease, and correct diagnosis after appropriate workup was completed. The 2010 McDonald criteria were used and, when necessary, lumbar puncture, serum, and evoked potentials testing. 142 new patient consults were completed in this time and included in this study. This study was reviewed and approved by the institutional review board of the University of California, Los Angeles.
Results: 32% of new patients did not meet diagnostic criteria for MS or were felt to have a much more likely alternate diagnosis. 9% of these non-MS patients were on disease modifying therapy to treat MS. The most common alternate diagnoses were headache (20%), spine spondylosis (11%), and white matter ischemic disease (11%). The diagnostic tests most likely to help differentiate MS from alternate diagnoses are recent imaging of the entire central nervous system and lumbar puncture.
Conclusions: This review highlights the importance of careful evaluation of a patient's presentation prior to diagnosing multiple sclerosis and also on receiving a referral for treatment options. Neurologists, and MS specialists especially, should re-evaluate an existing MS diagnosis given the high rate of misdiagnosis. Diseases misdiagnosed as MS vary but, concordant with some previous studies include headache, spine disease, and white matter ischemic disease.
Disclosure:
Marwa Kaisey: funding through National MS Society and unrestricted educational grant from Biogen.
Barbara Giesser: nothing to disclose
Abstract: EP1294
Type: ePoster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: Diagnosing multiple sclerosis involves evaluation of the patient history, examination, imaging, and ancillary testing. No one test can rule in nor rule out MS, and many diseases can mimic the often vague symptoms of MS or cause white matter lesions in the central nervous system. While specific diagnostic criteria exist with revisions under review, there is still room for error in this process. A survey of MS specialists found that 94% had evaluated at least one patient in the last year who had an incorrect diagnosis of MS. Studies of groups of misdiagnosed patients found migraine and psychiatric disease to be the most common correct diagnoses. We evaluated the referrals to our sub-specialty multiple sclerosis clinic in an effort to understand the types of and reasons for these errors.
Objectives: To identify the incidence of misdiagnosis of MS and any patterns or common mistakes that lead to these errors.
Methods: All new consults seen in an MS clinic from July 2016 - May 2017 were evaluated and categorized by initial diagnosis on referral, category of disease, and correct diagnosis after appropriate workup was completed. The 2010 McDonald criteria were used and, when necessary, lumbar puncture, serum, and evoked potentials testing. 142 new patient consults were completed in this time and included in this study. This study was reviewed and approved by the institutional review board of the University of California, Los Angeles.
Results: 32% of new patients did not meet diagnostic criteria for MS or were felt to have a much more likely alternate diagnosis. 9% of these non-MS patients were on disease modifying therapy to treat MS. The most common alternate diagnoses were headache (20%), spine spondylosis (11%), and white matter ischemic disease (11%). The diagnostic tests most likely to help differentiate MS from alternate diagnoses are recent imaging of the entire central nervous system and lumbar puncture.
Conclusions: This review highlights the importance of careful evaluation of a patient's presentation prior to diagnosing multiple sclerosis and also on receiving a referral for treatment options. Neurologists, and MS specialists especially, should re-evaluate an existing MS diagnosis given the high rate of misdiagnosis. Diseases misdiagnosed as MS vary but, concordant with some previous studies include headache, spine disease, and white matter ischemic disease.
Disclosure:
Marwa Kaisey: funding through National MS Society and unrestricted educational grant from Biogen.
Barbara Giesser: nothing to disclose