Contributions
Abstract: P656
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: Multiple Sclerosis (MS) specialists routinely evaluate misdiagnosed patients, or patients incorrectly assigned a diagnosis of MS. Cohorts of such patients have been described, yet the contemporary prevalence of MS misdiagnosis is unknown. Such data would confirm the impact of MS misdiagnosis, and further characterization of misdiagnosed patients would inform strategies for its prevention.
Objectives: Determine the prevalence of MS misdiagnosis in new patients referred for evaluation at two academic MS referral centers, the most common alternate diagnoses identified, and factors associated with misdiagnosis.
Methods: Electronic medical record documentation and MRIs from all new patient evaluations at the Cedars-Sinai Medical Center and the University of California, Los Angeles MS clinics performed from July 2016 to June 2017 were retrospectively reviewed. Predefined criteria identified patients with an established diagnosis of MS prior to referral: patients referred for any question regarding diagnosis of MS were excluded from analysis. Predefined criteria determined if a misdiagnosis of MS was identified during these evaluations and excluded patients with clinically isolated syndrome. Demographic data, comorbidities, neurological examination findings, radiologic and laboratory findings, and final diagnosis based on fulfillment of 2010 and 2017 McDonald Criteria were collected and analyzed using multivariable logistic regression.
Results: A total of 366 new patients were evaluated at the two centers, 236 of whom had a previously established MS diagnosis. 19/112 (17%) at Cedars-Sinai and 24/124 (19%) at UCLA were determined to have been misdiagnosed. Presentation with an atypical clinical syndrome (p< 0.0001) and atypical imaging (p< 0.0001) were the only factors significantly associated with MS misdiagnosis. The most common alternate diagnosis was migraine (14%). The misdiagnosed group received a total of 44 patient-years of unnecessary MS disease modifying therapy.
Conclusion: Misdiagnosis is common in patients with an established diagnosis of MS; in our combined referral cohort, 18% of patients who carried a pre-existing diagnosis of MS did not fulfill MS diagnostic criteria and had a more likely alternate diagnosis. Misapplication of McDonald Criteria appears to contribute to MS misdiagnosis. This high rate of misdiagnosis has significant implications for patient morbidity, healthcare costs, and MS research integrity.
Disclosure: Dr. Kaisey has nothing to disclose.
Dr. Solomon received consulting fees and research funding from Biogen.
Dr. Sicotte has nothing to disclose.
Dr. Giesser has nothing to disclose.
Abstract: P656
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: Multiple Sclerosis (MS) specialists routinely evaluate misdiagnosed patients, or patients incorrectly assigned a diagnosis of MS. Cohorts of such patients have been described, yet the contemporary prevalence of MS misdiagnosis is unknown. Such data would confirm the impact of MS misdiagnosis, and further characterization of misdiagnosed patients would inform strategies for its prevention.
Objectives: Determine the prevalence of MS misdiagnosis in new patients referred for evaluation at two academic MS referral centers, the most common alternate diagnoses identified, and factors associated with misdiagnosis.
Methods: Electronic medical record documentation and MRIs from all new patient evaluations at the Cedars-Sinai Medical Center and the University of California, Los Angeles MS clinics performed from July 2016 to June 2017 were retrospectively reviewed. Predefined criteria identified patients with an established diagnosis of MS prior to referral: patients referred for any question regarding diagnosis of MS were excluded from analysis. Predefined criteria determined if a misdiagnosis of MS was identified during these evaluations and excluded patients with clinically isolated syndrome. Demographic data, comorbidities, neurological examination findings, radiologic and laboratory findings, and final diagnosis based on fulfillment of 2010 and 2017 McDonald Criteria were collected and analyzed using multivariable logistic regression.
Results: A total of 366 new patients were evaluated at the two centers, 236 of whom had a previously established MS diagnosis. 19/112 (17%) at Cedars-Sinai and 24/124 (19%) at UCLA were determined to have been misdiagnosed. Presentation with an atypical clinical syndrome (p< 0.0001) and atypical imaging (p< 0.0001) were the only factors significantly associated with MS misdiagnosis. The most common alternate diagnosis was migraine (14%). The misdiagnosed group received a total of 44 patient-years of unnecessary MS disease modifying therapy.
Conclusion: Misdiagnosis is common in patients with an established diagnosis of MS; in our combined referral cohort, 18% of patients who carried a pre-existing diagnosis of MS did not fulfill MS diagnostic criteria and had a more likely alternate diagnosis. Misapplication of McDonald Criteria appears to contribute to MS misdiagnosis. This high rate of misdiagnosis has significant implications for patient morbidity, healthcare costs, and MS research integrity.
Disclosure: Dr. Kaisey has nothing to disclose.
Dr. Solomon received consulting fees and research funding from Biogen.
Dr. Sicotte has nothing to disclose.
Dr. Giesser has nothing to disclose.