Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers
Abstract
Background Multiple Sclerosis (MS) specialists routinely evaluate misdiagnosed patients, or patients incorrectly assigned a diagnosis of MS. Misdiagnosis has significant implications for patient morbidity and healthcare costs, yet its contemporary incidence is unknown. We examined the incidence of MS misdiagnosis in new patients referred to two academic MS referral centers, their most common alternate diagnoses, and factors associated with misdiagnosis. Methods Demographic data, comorbidities, neurological examination findings, radiographic and laboratory results, a determination of 2010 McDonald Criteria fulfillment, and final diagnoses were collected from all new patient evaluations completed at the Cedars-Sinai Medical Center and the University of California, Los Angeles MS clinics over twelve months. Results Of the 241 new patients referred with an established diagnosis of MS, 17% at Cedars-Sinai and 19% at UCLA were identified as having been misdiagnosed. The most common alternative diagnoses were migraine (16%), radiologically isolated syndrome (9%), spondylopathy (7%), and neuropathy (7%). Clinical syndromes and radiographic findings atypical for MS were both associated with misdiagnosis. The misdiagnosed group received approximately 110 patient-years of unnecessary MS disease modifying therapy. Conclusion MS misdiagnosis is common; in our combined cohort, almost 1 in 5 patients who carried an established diagnosis of MS did not fulfill contemporary McDonald Criteria and had a more likely alternate diagnosis.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a 2019 study in California, there were no cases of FND among 43 misdiagnosed MS patients referred to two MS tertiary care centers, although there were two cases (5%) of fibromyalgia.
“In contrast, in a 2019 study in California, there were no cases of FND among 43 misdiagnosed MS patients referred to two MS tertiary care centers, although there were two cases (5%) of fibromyalgia [35].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [35]
Misapplication and misinterpretation of MS diagnostic criteria may be responsible for many cases of MS misdiagnosis.
“Data from studies focused on MS [6, 35] suggest that misapplication and misinterpretation of MS diagnostic criteria may be responsible for many cases of misdiagnosis.”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [35]
Cites
Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., Fujihara, K., Havrdova, E., Hutchinson, M., Kappos, L., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22366 · Cited by 9,802 · see citing works
Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M. S., et al. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(17)30470-2 · Cited by 8,167 · see citing works
McDonald, W. I., Compston, A., Edan, G., Goodkin, D., Hartung, H., Lublin, F. D., McFarland, H. F., Paty, D. W., Polman, C. H., Reingold, S. C., et al. (2001) · Annals of Neurology · doi:10.1002/ana.1032 · Cited by 6,969 · see citing works
Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”
Polman, C. H., Reingold, S. C., Edan, G., Filippi, M., Hartung, H., Kappos, L., Lublin, F. D., Metz, L. M., McFarland, H. F., O'Connor, P. W., et al. (2005) · Annals of Neurology · doi:10.1002/ana.20703 · Cited by 5,017 · see citing works
Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity
Browne, P., Chandraratna, D., Angood, C., Tremlett, H., Baker, C., Taylor, B. V., & Thompson, A. J. (2014) · Neurology · doi:10.1212/wnl.0000000000000768 · Cited by 1,223 · see citing works
Diagnosis of multiple sclerosis: progress and challenges
Brownlee, W. J., Hardy, T. A., Fazekas, F., & Miller, D. H. (2017) · The Lancet · doi:10.1016/s0140-6736(16)30959-x · Cited by 701 · see citing works
Incidental MRI anomalies suggestive of multiple sclerosis: The radiologically isolated syndrome
Okuda, D. T., Mowry, E. M., Beheshtian, A., Waubant, E., Baranzini, S. E., Goodin, D. S., Hauser, S. L., & Pelletier, D. (2009) · Neurology · doi:10.1212/01.wnl.0000335764.14513.1a · Cited by 642 · see citing works
The contemporary spectrum of multiple sclerosis misdiagnosis
Solomon, A. J., Bourdette, D. N., Cross, A. H., Applebee, A., Skidd, P. M., Howard, D. B., Spain, R. I., Cameron, M. H., Kim, E., Mass, M. K., et al. (2016) · Neurology · doi:10.1212/wnl.0000000000003152 · Cited by 334 · see citing works
Self-citationConversion from clinically isolated syndrome to multiple sclerosis: a large multicentre study
Kuhle, J., Disanto, G., Dobson, R., Adiutori, R., Bianchi, L., Topping, J., Bestwick, J., Meier, U.-C., Marta, M., Costa, G. D., et al. (2015) · Multiple Sclerosis Journal · doi:10.1177/1352458514568827 · Cited by 299 · see citing works
MRI and the diagnosis of multiple sclerosis: expanding the concept of “no better explanation”
Charil, A., Yousry, T. A., Rovaris, M., Barkhof, F., Stefano, N. D., Fazekas, F., Miller, D. H., Montalbán, X., Simon, J. H., Polman, C. H., et al. (2006) · The Lancet Neurology · doi:10.1016/s1474-4422(06)70572-5 · Cited by 226 · see citing works
Major, E. O., Yousry, T. A., & Clifford, D. B. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(18)30040-1 · Cited by 188 · see citing works
“Undiagnosing” multiple sclerosis: The challenge of misdiagnosis in MS
Solomon, A. J., Klein, E. P., & Bourdette, D. (2012) · Neurology · doi:10.1212/wnl.0b013e318259e1b2 · Cited by 144 · see citing works
Self-citationLiu, S., Kullnat, J., Bourdette, D., Simon, J., Kraemer, D. F., Murchison, C., & Hamilton, B. E. (2013) · Multiple Sclerosis Journal · doi:10.1177/1352458512471874 · Cited by 82 · see citing works
Carmosino, M. J., Brousseau, K. M., Arciniegas, D. B., & Corboy, J. R. (2005) · Archives of Neurology · doi:10.1001/archneur.62.4.585 · Cited by 74 · see citing works
Alternative diagnoses in patients referred to specialized centers for suspected MS
Yamout, B. I., Khoury, S. J., Ayyoubi, N., Doumiati, H., Fakhreddine, M., Ahmed, S. F., Tamim, H., Al-Hashel, J. Y., Behbehani, R., & Alroughani, R. (2017) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2017.09.016 · Cited by 54 · see citing works
Misdiagnosis of multiple sclerosis and β-interferon
Poser, C. M. (1997) · The Lancet · doi:10.1016/s0140-6736(05)63920-7 · Cited by 43 · see citing works
A clinico-pathoanatomical study of multiple sclerosis diagnosis
Engell, T. (1988) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1988.tb03616.x · Cited by 42 · see citing works
Misdiagnosis of Multiple Sclerosis
Herndon, R. M., & Brooks, B. (1985) · Seminars in Neurology · doi:10.1055/s-2008-1041505 · Cited by 32 · see citing works
Characteristics of patients found not to have multiple sclerosis.
(1984) · Europe PMC (PubMed Central) · Cited by 27 · see citing works
(1987) · PubMed · Cited by 16 · see citing works
Boster, A. L., Caon, C., Perumal, J. S., et al. (2008) · Multiple Sclerosis Journal · doi:10.1177/1352458507088156 · Cited by 12 · see citing works
Solomon, A. J. (2019) · Multiple Sclerosis Journal · doi:10.1177/1352458518813107 · Cited by 7 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Walzl, D., Solomon, A. J., & Stone, J. (2022) · Journal of Neurology · doi:10.1007/s00415-021-10436-6 · Cited by 62 · see citing works
Self-citationBorrelli, S., Martire, M. S., Stölting, A., Vanden Bulcke, C., Pedrini, E., Guisset, F., Bugli, C., Yildiz, H., Pothen, L., Elands, S., et al. (2024) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000200253 · Cited by 61 · see citing works
Cervical spinal cord susceptibility-weighted MRI at 7T: application to multiple sclerosis
Clarke, M. A., Witt, A. A., Robison, R. K., Fleishman, S., Combes, A. J. E., Houston, D., Prock, L. E., Sweeney, G., O'Grady, K. P., McKnight, C. D., et al. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.120460 · Cited by 21 · see citing works
Toljan, K., Amin, M., & Ontaneda, D. (2025) · Clinical Radiology · doi:10.1016/j.crad.2025.106984 · Cited by 9 · see citing works
Genetic diseases misdiagnosed as multiple sclerosis: Observational study and review of literature
Mandia, D., Shor, N., Carlson, A. K., Obusez, E., Cohen, J. A., Fenu, S., Salsano, E., La Piana, R., Durães, J., Faustino, P., et al. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106439 · Cited by 9 · see citing works
Aldraihem, M., Alyami, W., AlQahtani, E., Saeed, L., AlDosary, R., Altowaijri, G., & Almutlaq, A. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106779
Misdiagnosis of multiple sclerosis: Time for action
Brownlee, W. J., & Solomon, A. J. (2021) · Multiple Sclerosis Journal · doi:10.1177/13524585211005367 · Cited by 15 · see citing works
Self-citation
- Authors
- Kaisey, M., Solomon, A. J., Luu, M., Giesser, B. S., & Sicotte, N. L.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Corresponding author
- Kaisey, Marwa
- Venue
- Multiple Sclerosis and Related Disorders
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 30
- Pages
- 51-56
- ISSN
- 2211-0348 (ISSN-L)
- OpenAlex
- W2911408542
- Semantic Scholar
- 4d290541ae8d134beb5c6bcc20d1928099efac73
- Cited by
- 148
- References
- 22
- Citations by year
- 2026: 11 · 2025: 22 · 2024: 19 · 2023: 25 · 2022: 26 · 2021: 21 · 2020: 17 · 2019: 7
- FWCI
- 11.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Multiple Sclerosis and Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, misdiagnosis, diagnostic accuracy, McDonald criteria, radiologically isolated syndrome, migraine, neuropathy, atypical radiographic findings
- MeSH terms
- Academic Medical Centers, Adult, Diagnostic Errors, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Retrospective Studies, Incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
