Study finds nearly one in five misdiagnosed as having MS

Evelyn Lewin

24/04/2019 2:39:19 PM

Diagnosing multiple sclerosis is not always straightforward.

Patient and doctor
Lead researcher Dr Marwa Kaisey said the cost of MS misdiagnosis to the patient is ‘medically, psychologically and financially’ significant.

A new study has found that almost one in five patients diagnosed with multiple sclerosis (MS) were misdiagnosed.
The retrospective US study, published in Multiple Sclerosis and Related Disorders, analysed 241 people diagnosed with MS. Of those patients, 17% at Cedars-Sinai Medical Center and 19% at UCLA Health were identified as having been misdiagnosed.
Researchers found the most common alternative diagnosis was migraine (16%). Radiologically isolated syndrome (RIS) – a condition in which the results of MRI scans determined that the people had MS, despite them not experiencing any other symptoms linked to MS – was found in 9% of cases.
Meanwhile, 7% were found to have spondylopathy, and a further 7% neuropathy.
‘The diagnosis of MS is tricky,’ lead researcher Dr Marwa Kaisey, from the Cedars-Sinai Medical Center in Los Angeles, said.
‘Both the symptoms and MRI testing results can look like other conditions, such as stroke, migraines, and vitamin B12 deficiency.
‘Misdiagnosis appeared to be associated with misapplication of MS diagnostic criteria, specifically overreliance on – or misinterpretation of – radiographic findings in patients with syndromes atypical for MS.’
Of the people misdiagnosed with MS, many received treatment for the condition for four years before receiving a correct diagnosis.
The estimated costs of unnecessary treatments identified in this study alone was found to be almost $10 million. Researchers also found that the misdiagnosed group received approximately 110 patient-years of unnecessary MS disease modifying therapy.
‘I’ve seen patients suffering side effects from the medication they were taking for a disease they didn’t have. Meanwhile, they weren’t getting treatment for what they did have,’ Dr Kaisey said.
‘The cost to the patient is huge – medically, psychologically, financially.’
According to MS Australia, more than 25,600 people are affected by MS in Australia, with more than two million people diagnosed with the condition worldwide.
And yet, as MS Research Australia states, diagnosing MS is ‘not always straightforward’.
While the study found migraine to top the list of potential alternative diagnoses, MS Research Australia notes that other differential diagnoses include:

  • other autoimmune or inflammatory diseases
  • brain infections
  • other demyelinating diseases (including neuromyelitis optica)
  • genetic disorders
  • copper or B12 deficiency
  • structural abnormalities. 
This is not the first study to find a high rate of misdiagnosis in patients with MS.
Research published in Neurology in 2016 collated data from neurologists at four academic MS centres on patients determined to have been misdiagnosed with MS. That study found 110 patients were misdiagnosed with MS.
Duration of misdiagnosis was 10 years or longer in 36 patients (33%), with 34 patients (31% of participants) experiencing unnecessary morbidity because of misdiagnosis.
‘The first step, which is what we’ve done here, is to identify the problem,’ Dr Kaisey said of this new study.
‘So now we’re working on potential solutions.’

differential diagnoses misdiagnosis MS multiple sclerosis

newsGP weekly poll Would the reintroduction of MBS items for GPs to trace and report on electrocardiogram (ECGs) be beneficial to patients?

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