The frequency and characteristics of multiple sclerosis misdiagnosis referrals to a tertiary center in Saudi Arabia
Abstract
Objective To assess the frequency, contributing factors, and clinical implications of multiple sclerosis (MS) misdiagnosis among referrals to a tertiary MS center in Saudi Arabia. Methods We retrospectively reviewed records of 416 patients referred to the MS clinic at King Fahad Medical City, Riyadh, between January 2018 and January 2024. After excluding 12 patients due to incomplete data, 404 remained. Referrals were categorized as established MS, possible MS, clinically isolated syndrome (CIS), or radiologically isolated syndrome (RIS). Diagnostic reassessment was performed using the 2017 McDonald criteria. Misdiagnosed cases were reclassified, and alternative diagnoses recorded. Results Of 257 patients referred with an established MS diagnosis, 17 (6.6 %; 95 % Confidence Interval (CI): 4.1-10.4) were misdiagnosed. Among 137 referrals for a possible MS, 46 (33.6 %; CI: 26.0-41.9) had non-MS conditions. Common alternative diagnoses included nonspecific white matter lesions (41.2 %) and migraine (29.4 %). Cerebrospinal fluid (CSF) oligoclonal bands were positive in 78.2 % of confirmed MS cases and 6.7 % of misdiagnosed cases. Unnecessary MS treatment was given to majority of misdiagnosed patients, costing 849,921 SAR (∼226,645 USD). Conclusion MS misdiagnosis is frequent, especially in atypical cases or non-specialist evaluations. Early referral and strict use of McDonald's criteria may reduce diagnostic errors and healthcare costs.
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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
MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines
Filippi, M., Rocca, M. A., Ciccarelli, O., De Stefano, N., Evangelou, N., Kappos, L., Rovira, A., Sastre-Garriga, J., Tintorè, M., Frederiksen, J. L., et al. (2016) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00393-2 · Cited by 880 · 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
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
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
Differential diagnosis of suspected multiple sclerosis: an updated consensus approach
Solomon, A. J., Arrambide, G., Brownlee, W. J., Flanagan, E. P., Amato, M. P., Amezcua, L., Banwell, B., Barkhof, F., Corboy, J. R., Correale, J. D., et al. (2023) · The Lancet Neurology · doi:10.1016/s1474-4422(23)00148-5 · Cited by 161 · see citing works
Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers
Kaisey, M., Solomon, A. J., Luu, M., Giesser, B. S., & Sicotte, N. L. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.01.048 · Cited by 148 · 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
Multiple Sclerosis: The Problem of Incorrect Diagnosis
Rudick, R. A. (1986) · Archives of Neurology · doi:10.1001/archneur.1986.00520060042015 · Cited by 83 · see citing works
Overdiagnosis of multiple sclerosis and magnetic resonance imaging criteria
Nielsen, J. M., Korteweg, T., Barkhof, F., Uitdehaag, B. M. J., & Polman, C. H. (2005) · Annals of Neurology · doi:10.1002/ana.20632 · Cited by 72 · 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
Common Clinical and Imaging Conditions Misdiagnosed as Multiple Sclerosis
Sıva, A. (2017) · Neurologic Clinics · doi:10.1016/j.ncl.2017.08.014 · Cited by 43 · see citing works
Differential diagnosis of suspected multiple sclerosis: global health considerations
Correale, J. D., Solomon, A. J., Cohen, J. A., Banwell, B., Gracia, F., Gyang, T. V., Bedoya, F., Harnegie, M. P., Hemmer, B., Jacob, A., et al. (2024) · The Lancet Neurology · doi:10.1016/s1474-4422(24)00256-4 · Cited by 33 · see citing works
Multiple sclerosis or multiple possibilities
Rudick, R. A., & Miller, A. (2012) · Neurology · doi:10.1212/wnl.0b013e318259e2e2 · Cited by 33 · see citing works
Gaitán, M. I., Sanchez, M., Farez, M., et al. (2021) · Multiple Sclerosis Journal · doi:10.1177/13524585211067521 · Cited by 31 · see citing works
Multiple Sclerosis Misdiagnosis: A Persistent Problem to Solve
Gaitán, M. I., & Correale, J. D. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00466 · Cited by 30 · see citing works
Diagnostic approach in multiple sclerosis with MRI: an update
Weidauer, S., Raab, P., & Hattingen, E. (2021) · Clinical Imaging · doi:10.1016/j.clinimag.2021.05.025 · Cited by 18 · see citing works
Tieppo, E. M. D. S., Silva, G. D., da Silva, T. F. F., de Araujo, R. S., de Oliveira, M. B., Spricigo, M. G. P., Pimentel, G. A., Campana, I. G., Castrillo, B. B., Mendes, N. T., et al. (2023) · Multiple Sclerosis Journal · doi:10.1177/13524585231199323 · Cited by 10 · see citing works
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- Authors
- Aldraihem, M., Alyami, W., AlQahtani, E., Saeed, L., AlDosary, R., Altowaijri, G., & Almutlaq, A.
- Affiliations
- King Fahd Medical City (SA)
- Corresponding author
- Almutlaq, Ahmad
- Venue
- Multiple Sclerosis and Related Disorders
- Publisher
- Elsevier BV
- Published
- 2025-12
- Volume
- 104
- Pages
- 106779
- ISSN
- 2211-0348 (ISSN-L)
- OpenAlex
- W4414804309
- Semantic Scholar
- 35d146cc01bcc411801d20a42a4b54a0eeb3a103
- Cited by
- 0
- References
- 18
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Multiple Sclerosis and Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- King Fahad Medical City (024\u2013015)
- 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 › Cerebral Venous Sinus Thrombosis
- Keywords
- multiple sclerosis, misdiagnosis, diagnostic errors, clinically isolated syndrome, radiologically isolated syndrome, McDonald criteria, alternative diagnoses, migraine, cerebrospinal fluid oligoclonal bands, unnecessary treatment, health care costs, tertiary care referral
- MeSH terms
- Adolescent, Adult, Diagnostic Errors, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Referral and Consultation, Retrospective Studies, Saudi Arabia, Young Adult, Tertiary Care Centers
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