Contributions
Abstract: P841
Type: Poster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: The diagnostic criteria for Multiple Sclerosis (MS) continue to evolve over the years. Yet the recommendations for considering and excluding alternative diagnoses have remained relatively consistent. Traditionally the workup has included extensive serologic testing for conditions that demonstrate imaging and/or clinical findings mimicking MS. While aspects of this workup have become routine in clinical practice, the diagnostic utility of such testing has not been well established. It has been suggested that patients who present with classic findings for MS, an extensive serologic workup for MS mimics may be unnecessary. We hypothesize that such a comprehensive screening for MS mimickers has no significant clinical benefit for patient's meeting diagnostic criteria for MS and may yield to additional, unnecessary testing.
Objectives: To establish how often patients referred to our tertiary Neuro-immunology clinic have been previously tested for MS mimics and to determine the frequency that this serologic testing has lead to alternative diagnosis and treatment. To analyze the frequency that positive MS mimic testing leads to further testing, inappropriate treatment or adverse outcomes.
Methods: We are performing a retrospective chart review of referrals to the University of Michigan MS clinic from approximately January 1, 2014 to December 31, 2016. Patients will be divided into four groups: [a] those meeting 2010 McDonald criteria for clinically definite MS, [b] clinically isolated syndrome (CIS), [c] radiographically isolated syndrome (RIS) and [d] those who did not meet criteria outline above. Those with a diagnosis of MS made by an outside provider more than a year ago or with another neuro-immunologic diagnosis will be excluded. Within this group of patients, we will then perform thorough reviews of serologic testing, CSF analysis, imaging studies and patient outcomes.
Results: On initial review of approximately 25 charts, there were 0 cases in which serologic testing resulted in a diagnosis other than MS or CIS. During this initial review, a single case was identified in which positive serum testing done prior to referral our institution led to additional, unnecessary testing.
Conclusions: We expect for patients who meet the McDonald Criteria for MS, an extensive workup for mimics will not result in any change in diagnosis. We fear that false positive results may lead to consequences such as further testing and treatment.
Disclosure:
Anna Shah: Nothing to disclose
Ben Stewart: Nothing to disclose
Colin Lyness: Nothing to disclose
Tiffany Braley: Dr. Braley conducts investigator-initiated studies funded by the National Multiple Sclerosis Society and the American Sleep Medicine Foundation. Dr. Braley recently completed a sleep apnea clinical trial that received material support, but no financial support, from Biogen-Idec. She is site principal investigator for several industry-funded studies of MS immunotherapeutics at the University of Michigan (sponsors include Genzyme-Sanofi and Genentech-Roche). She is also named in a provisional patent, held by the University of Michigan, concerning treatment for sleep apnea.
Abstract: P841
Type: Poster
Abstract Category: Clinical aspects of MS - 1 Diagnosis and differential diagnosis
Background: The diagnostic criteria for Multiple Sclerosis (MS) continue to evolve over the years. Yet the recommendations for considering and excluding alternative diagnoses have remained relatively consistent. Traditionally the workup has included extensive serologic testing for conditions that demonstrate imaging and/or clinical findings mimicking MS. While aspects of this workup have become routine in clinical practice, the diagnostic utility of such testing has not been well established. It has been suggested that patients who present with classic findings for MS, an extensive serologic workup for MS mimics may be unnecessary. We hypothesize that such a comprehensive screening for MS mimickers has no significant clinical benefit for patient's meeting diagnostic criteria for MS and may yield to additional, unnecessary testing.
Objectives: To establish how often patients referred to our tertiary Neuro-immunology clinic have been previously tested for MS mimics and to determine the frequency that this serologic testing has lead to alternative diagnosis and treatment. To analyze the frequency that positive MS mimic testing leads to further testing, inappropriate treatment or adverse outcomes.
Methods: We are performing a retrospective chart review of referrals to the University of Michigan MS clinic from approximately January 1, 2014 to December 31, 2016. Patients will be divided into four groups: [a] those meeting 2010 McDonald criteria for clinically definite MS, [b] clinically isolated syndrome (CIS), [c] radiographically isolated syndrome (RIS) and [d] those who did not meet criteria outline above. Those with a diagnosis of MS made by an outside provider more than a year ago or with another neuro-immunologic diagnosis will be excluded. Within this group of patients, we will then perform thorough reviews of serologic testing, CSF analysis, imaging studies and patient outcomes.
Results: On initial review of approximately 25 charts, there were 0 cases in which serologic testing resulted in a diagnosis other than MS or CIS. During this initial review, a single case was identified in which positive serum testing done prior to referral our institution led to additional, unnecessary testing.
Conclusions: We expect for patients who meet the McDonald Criteria for MS, an extensive workup for mimics will not result in any change in diagnosis. We fear that false positive results may lead to consequences such as further testing and treatment.
Disclosure:
Anna Shah: Nothing to disclose
Ben Stewart: Nothing to disclose
Colin Lyness: Nothing to disclose
Tiffany Braley: Dr. Braley conducts investigator-initiated studies funded by the National Multiple Sclerosis Society and the American Sleep Medicine Foundation. Dr. Braley recently completed a sleep apnea clinical trial that received material support, but no financial support, from Biogen-Idec. She is site principal investigator for several industry-funded studies of MS immunotherapeutics at the University of Michigan (sponsors include Genzyme-Sanofi and Genentech-Roche). She is also named in a provisional patent, held by the University of Michigan, concerning treatment for sleep apnea.