Research: Misdiagnosis in MS

Andrew J. Solomon, Eran P. Klein, Dennis Bourdette “Undiagnosing” multiple sclerosis: The challenge of misdiagnosis in MS Neurology WNL.0b013e318259e1b2; published ahead of print May 11, 2012,

Objective: To describe the clinical characteristics of encounters with patients misdiagnosed with multiple sclerosis (MS).

Methods: A cross-sectional Internet-based physician survey of MS specialists was performed.

Results: The response rate for the survey was 50.4%. Of those who responded, the majority (95%) reported having evaluated 1 or more patients who had been diagnosed with MS, but who they strongly felt did not have MS, within the last year. The majority of respondents (>90%) also reported the use of disease-modifying therapy in a proportion of these patients. Most respondents (94%) found clinical encounters with these patients equally or more challenging than giving a new diagnosis of MS. Fourteen percent of respondents reported that they did not always inform such patients of their opinion that they did not have MS.

Conclusions: The misdiagnosis of MS is common and has significant consequences for patient care and health care system costs. Caring for a patient with a misdiagnosis of MS is challenging, and at times honest disclosure of a misdiagnosis represents an important ethical concern for neurologists. More data are needed on this patient population to improve diagnostic acumen and the care of these patients. 

From the survey results, they emphasized the following: 1) nearly all MS specialists who completed the survey had seen patients in the prior year for whom they thought an MS diagnosis was incorrect; 2) many of the MSers with an incorrect MS diagnosis were actually taking MS disease-modifying drugs (DMD); 3) many MS specialists found it difficult to “take away” the MS diagnosis; and 4) the MS specialists decided, in some cases, not to inform the patient about their opinion. 

The suspect diagnosis was commonly based on non-specific MRI changes, sometimes occurring in patients who had cardiovascular risk factors or migraine. The authors called attention to the difficulty neurologists reported reversing an incorrect diagnosis. The findings suggest over-reliance on MRI to make a diagnosis, inappropriate use of DMD, and the difficulty neurologists have dealing with MS misdiagnosis.

You can see some of the financial cost of misdiagnosis above and the human cost of misdiagnosis below.