Contributions
Abstract: P655
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: The McDonald criteria are the internationally accepted method for diagnosing Multiple Sclerosis (MS) but should only be applied to typical episodes compatible with a first presentation of MS and require exclusion of other causes of CNS demyelination including infections, connective tissue diseases, other neuroinflammatory diseases and metabolic causes. Internationally misdiagnosis rates up to 20% are reported. The 2017 revisions to the McDonald criteria allow for the diagnosis of MS after a single clinical episode and compatible MRI resulting in earlier time to diagnosis. Unless care is take to exclude MS mimics this may lower the specificity of the criteria and result in misdiagnosis of MS.
Aim: To audit MS mimic workup adherence in a cohort of clinically isolated syndrome (CIS) patients presenting to a tertiary referral hospital between 2014 and 2017.
Methods: Results of investigations during diagnostic work-up were analysed including autoimmune connective tissue disease screening (ANA, ENA, ANCA), infections (Lyme serology), Aquaporin 4 antibodies (AQP-4ab) and serum ACE, where appropriate, vitamin B12 levels as well as results of oligoclonal banding (OCB) in CSF were recorded. The clinical presentation and whether it was a “typical” CIS was noted. The retrospective diagnosis of CIS?MS was reviewed with currently available clinical information.
Results: 104 patients were identified. All patients had MRI findings compatible with a diagnosis of MS based on 2017 McDonald Criteria. 20% of patients had an “atypical” CIS (e.g. bilateral optic neuritis, optic neuritis plus seizure) 86% of patients had a lumbar puncture: all except one patient had unmatched OCB in CSF. ANA, ENA, ANCA were checked in 84%, 78% and 80% respectively and a minority had a positive result (14% had a positive ANA, 14% had a positive ANCA, all with negative MPO and PR3). Internationally it is reported that up to 43% of MS patients and 30% of healthy controls have low titre ANA positivity. 1 patient had a high CSF ACE. When indicated, Lyme serology and AQP-4ab were recorded in 71% & 65%respectively and B12 levels (84%) were all within the normal ranges.
Conclusion: The audit findings are in keeping with other data that low level autoantibodies are frequently found in patients with CIS and are rarely helpful. In our cohort no patients were misdiagnosed with CIS/MS but the audit found that diagnostic tests for mimic conditions could be more extensively recorded.
Disclosure: Andrew Lockhart: nothing to disclose
Nuala McNicholas: nothing to disclose
Karen O´Connell: nothing to disclose
Siew Mei Yap: nothing to disclose
Niall Tubridy has received research support from Bayer-Schering, the Health Research Board of Ireland and MS Ireland.
Christopher McGuigan has received personal compensation for activities with Biogen, Bayer, EMD Serono, Novartis, Genzyme and Teva.
Abstract: P655
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: The McDonald criteria are the internationally accepted method for diagnosing Multiple Sclerosis (MS) but should only be applied to typical episodes compatible with a first presentation of MS and require exclusion of other causes of CNS demyelination including infections, connective tissue diseases, other neuroinflammatory diseases and metabolic causes. Internationally misdiagnosis rates up to 20% are reported. The 2017 revisions to the McDonald criteria allow for the diagnosis of MS after a single clinical episode and compatible MRI resulting in earlier time to diagnosis. Unless care is take to exclude MS mimics this may lower the specificity of the criteria and result in misdiagnosis of MS.
Aim: To audit MS mimic workup adherence in a cohort of clinically isolated syndrome (CIS) patients presenting to a tertiary referral hospital between 2014 and 2017.
Methods: Results of investigations during diagnostic work-up were analysed including autoimmune connective tissue disease screening (ANA, ENA, ANCA), infections (Lyme serology), Aquaporin 4 antibodies (AQP-4ab) and serum ACE, where appropriate, vitamin B12 levels as well as results of oligoclonal banding (OCB) in CSF were recorded. The clinical presentation and whether it was a “typical” CIS was noted. The retrospective diagnosis of CIS?MS was reviewed with currently available clinical information.
Results: 104 patients were identified. All patients had MRI findings compatible with a diagnosis of MS based on 2017 McDonald Criteria. 20% of patients had an “atypical” CIS (e.g. bilateral optic neuritis, optic neuritis plus seizure) 86% of patients had a lumbar puncture: all except one patient had unmatched OCB in CSF. ANA, ENA, ANCA were checked in 84%, 78% and 80% respectively and a minority had a positive result (14% had a positive ANA, 14% had a positive ANCA, all with negative MPO and PR3). Internationally it is reported that up to 43% of MS patients and 30% of healthy controls have low titre ANA positivity. 1 patient had a high CSF ACE. When indicated, Lyme serology and AQP-4ab were recorded in 71% & 65%respectively and B12 levels (84%) were all within the normal ranges.
Conclusion: The audit findings are in keeping with other data that low level autoantibodies are frequently found in patients with CIS and are rarely helpful. In our cohort no patients were misdiagnosed with CIS/MS but the audit found that diagnostic tests for mimic conditions could be more extensively recorded.
Disclosure: Andrew Lockhart: nothing to disclose
Nuala McNicholas: nothing to disclose
Karen O´Connell: nothing to disclose
Siew Mei Yap: nothing to disclose
Niall Tubridy has received research support from Bayer-Schering, the Health Research Board of Ireland and MS Ireland.
Christopher McGuigan has received personal compensation for activities with Biogen, Bayer, EMD Serono, Novartis, Genzyme and Teva.