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Cited by 334Multiple Sclerosis Research StudiesClinical Reasoning and Diagnostic SkillsPeripheral Neuropathies and Disorders

The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index; none of the 21 sources its claims cite is checked for support yet.

The contemporary spectrum of multiple sclerosis misdiagnosis

Open access
Solomon, Andrew J., Bourdette, Dennis N., Cross, Anne H., Applebee, Angela, Skidd, Philip M., Howard, Diantha B., Spain, Rebecca I., Cameron, Michelle H., Kim, Edward, Mass, Michele K., Yadav, Vijayshree, Whitham, Ruth H., Longbrake, Erin E., Naismith, Robert T., Wu, Gregory F., Parks, Becky J., Wingerchuk, Dean M., Rabin, Brian L., Toledano, Michel, Tobin, W. Oliver, Kantarci, Orhun H., Carter, Jonathan L., Keegan, B. Mark, Weinshenker, Brian G.·2016·Neurology
DOI 10.1212/wnl.0000000000003152PMC PMC5047038
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Abstract

OBJECTIVE: To characterize patients misdiagnosed with multiple sclerosis (MS). METHODS: Neurologists at 4 academic MS centers submitted data on patients determined to have been misdiagnosed with MS. RESULTS: Of 110 misdiagnosed patients, 51 (46%) were classified as "definite" and 59 (54%) "probable" misdiagnoses according to study definitions. Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%). Duration of misdiagnosis was 10 years or longer in 36 (33%) and an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%). Seventy-seven (70%) received disease-modifying therapy and 34 (31%) experienced unnecessary morbidity because of misdiagnosis. Four (4%) participated in a research study of an MS therapy. Leading factors contributing to misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms. CONCLUSIONS: Misdiagnosis of MS leads to unnecessary and potentially harmful risks to patients. Misinterpretation and misapplication of MS clinical and radiographic diagnostic criteria are important contemporary contributors to misdiagnosis.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a 4-center study, 110 patients previously diagnosed with MS were determined by MS specialists to have been misdiagnosed; common alternative diagnoses were migraine, fibromyalgia, nonspecific neurologic symptoms with abnormal MRI, conversion/psychogenic disorders, and NMOSD. Misdiagnosis was often prolonged, frequently led to unnecessary disease-modifying therapy, and was commonly attributed to misapplication of clinical and radiographic MS diagnostic criteria.

Key findings

  • Of 110 misdiagnosed patients, 51 (46%) were classified as “definite” and 59 (54%) as “probable” misdiagnoses; 93 (85%) were women, mean age was 49 ± 11 years.
  • The most frequent alternative diagnoses were migraine alone or in combination (24, 22%), fibromyalgia (16, 15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI (13, 12%), conversion or psychogenic disorder (12, 11%), and NMOSD (7, 6%).
  • Misdiagnosis lasted 10 years or longer in 36 patients (33%); an earlier missed opportunity for correct diagnosis was identified in 79 (72%); 77 (70%) received disease-modifying therapy, and 34 (31%) experienced unnecessary morbidity. Four patients (4%) participated in a research study of an MS therapy.
  • Leading contributors were consideration of symptoms atypical for demyelinating disease (72, 65%), lack of corroborative objective evidence of a CNS lesion for historical attacks (53, 48%), and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms (66, 60%).

Methods

  • Twenty-three neurologists with MS subspecialty training/practice focus at 4 US academic MS centers (University of Vermont, Oregon Health & Science University, Washington University, Mayo Clinic) submitted data on patients determined to have been misdiagnosed with MS.
  • Patients were identified prospectively during 13 months or shortly before study initiation; data were collected August 1, 2014, to September 1, 2015. Inclusion required prior diagnosis of MS by another physician; patients for whom MS was only being considered but not firmly diagnosed were excluded.
  • “Definite misdiagnosis” required a definitively made alternative diagnosis based on clinical, laboratory, and neuroimaging evaluation; “probable misdiagnosis” required a suspected alternative diagnosis and failure to meet MS diagnostic criteria. Data were entered via a REDCap web form; neurologists also assessed whether inappropriate application of clinical or radiographic MS diagnostic criteria contributed to misdiagnosis.

Limitations

  • Stated: participating neurologists may have been incorrect in assessing misdiagnosis; lack of specific biomarkers for the disorders mistaken for MS means experts might disagree on the correct diagnosis; selection and referral bias likely influenced patient characteristics; no frequency estimate of MS misdiagnosis was obtained; contributor assessments may be speculative because neurologists usually did not make the initial incorrect MS diagnosis; hindsight bias may have influenced opinions about earlier missed opportunities.
  • Evident from the design: the study reports a referred/academic-center case series without a population denominator, so it cannot establish incidence or prevalence of misdiagnosis; data were collected by treating neurologists using a non-identifiable web form, and no independent adjudication or validation of alternative diagnoses is described.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1212/wnl.0000000000003152

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 21 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    An earlier opportunity to make a correct diagnosis was identified for 79 (72%) of misdiagnosed patients.

    “an earlier opportunity to make a correct diagnosis was identified for 79 patients (72%).”
    • Also stated in: § Contributors to misdiagnosis. · boosted
      “Neurologists identified “clear evidence of an earlier missed opportunity to make a correct diagnosis” in 79 (72%) of misdiagnosed patients”
    Quote in the paperSubstantial claim
  • Findingown data

    Fibromyalgia was reported significantly more often by Mayo Clinic neurologists than by neurologists at the other institutions (p=0.04).

    “Fibromyalgia was reported significantly more often by Mayo Clinic neurologists than the other institutions (p 5 0.04)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Presumed migraine-associated white matter lesions were often used to document dissemination in space imaging criteria.

    “Presumed migraine-associated white matter lesions were often used to document dissemination in space imaging criteria.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Neurologists noted that in 8 patients where CSF was initially performed, an initial erroneous interpretation of the results contributed to misdiagnosis.

    “Neurologists noted that in 8 of the patients where CSF was initially performed, an initial erroneous interpretation of the results contributed to misdiagnosis (i.e., OCBs were elevated both in serum and CSF).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.
  • Findingown data

    In patients with migraine, migrainous symptoms mistaken for demyelinating attacks were incorrectly used to satisfy dissemination in time criteria.

    “In the patients with migraine, neurologists specified that migrainous symptoms mistaken for demyelinating attacks were incorrectly used to satisfy dissemination in time criteria.”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one. 18
  • Probably not a substantial claim. 10
  • The quote only partly states this claim. 2

  • It may state two separate claims as one.

    Findingown data

    Twenty-six (24%) of 110 misdiagnosed patients were exposed to 2 immunomodulatory therapies, 6 (5%) to 3, 7 (6%) to 4, and 1 (1%) to 5.

    “Twenty-six patients (24%) were exposed to 2 therapies, 6 (5%) to 3 therapies, 7 (6%) to 4 therapies, and 1 (1%) to 5 therapies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Four (4%) of 110 misdiagnosed patients participated in a research study of an MS therapy.

    “Four (4%) participated in a research study of an MS therapy.”
    • Also stated in: § Contributors to misdiagnosis. · plain
      “Four patients (4%) participated in clinical trials for MS therapeutics.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Inappropriate interpretation of symptoms as relapses, lack of objective demonstration that historical symptoms were demyelinating events, and misinterpretation of MRI were all identified as contributors to misdiagnosis.

    “Inappropriate interpretation of symptoms as relapses, lack of objective demonstration that historical symptoms were demyelinating events, and misinterpretation of MRI were all identified as contributors to misdiagnosis (table 3).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.

  • It may state two separate claims as one. The quote only partly states this claim.

    Findingown data

    Of 7 patients with NMOSD misdiagnosed as MS, 5 were seropositive for anti-aquaporin-4 antibodies, one was seronegative, and serostatus for one was not reported.

    “Of 7 patients with NMOSD, 5 were seropositive for anti-aquaporin-4 antibodies, one was seronegative, and serostatus for one was not reported.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    CSF was evaluated in 74 (67%) of 110 misdiagnosed patients at the time of initial misdiagnosis, and specific results were available for review in 52.

    “CSF was evaluated in 74 patients (67%) at the time of their initial misdiagnosis, and specific results were available for review in 52.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Six patients diagnosed with NMOSD had a history of optic neuritis, 6 had a history of a longitudinally extensive spinal cord lesion, and one had a history of intractable vomiting or hiccoughs.

    “Six patients diagnosed with NMOSD had a history of optic neuritis, 6 had a history of a longitudinally extensive spinal cord lesion, and one had a history of “intractable vomiting or hiccoughs.””
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Among 110 misdiagnosed patients, the most frequent alternative diagnoses were migraine alone or in combination (24, 22%), fibromyalgia (16, 15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI (13, 12%), conversion or psychogenic disorders (12, 11%), and NMOSD (7, 6%).

    “Alternate diagnoses included migraine alone or in combination with other diagnoses 24 (22%), fibromyalgia 16 (15%), nonspecific or nonlocalizing neurologic symptoms with abnormal MRI 13 (12%), conversion or psychogenic disorders 12 (11%), and neuromyelitis optica spectrum disorder 7 (6%).”
    • Also stated in: § RESULTS · plain
      “The five most frequent alternative diagnoses reported by participating neurologists comprised 66% of the misdiagnosed patients (table 1), and included migraine alone or in combination with additional diagnoses, fibromyalgia, nonspecific or nonlocalizing neurologic symptoms with abnormal MRI, conversion or psychogenic disorder, and NMOSD.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The alternative diagnoses assigned by participating neurologists are correct.

  • It may state two separate claims as one.

    Findingown data

    Leading factors contributing to misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms.

    “Leading factors contributing to misdiagnosis were consideration of symptoms atypical for demyelinating disease, lack of corroborative objective evidence of a CNS lesion as satisfying criteria for MS attacks, and overreliance on MRI abnormalities in patients with nonspecific neurologic symptoms.”
    • Also stated in: § Contributors to misdiagnosis. · plain
      “Inappropriate interpretation of symptoms as relapses, lack of objective demonstration that historical symptoms were demyelinating events, and misinterpretation of MRI were all identified as contributors to misdiagnosis (table 3).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.

  • It may state two separate claims as one.

    Findingown data

    More than two-thirds of the patients were exposed to immunomodulatory therapy, almost a third for 10 years or longer.

    “More than two-thirds of the patients were exposed to immunomodulatory therapy, almost a third for 10 years or longer.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Fourteen misdiagnosed patients received natalizumab.

    “Fourteen patients received natalizumab”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Participating MS specialists indicated a number of morbidities experienced by patients in this study as a result of misdiagnosis, including one patient who died having a misdiagnosis of MS where appropriate therapies for NMOSD were not provided.

    “participating MS specialists indicated a number of morbidities experienced by patients in this study as a result of misdiagnosis, including one patient who died having a misdiagnosis of MS where appropriate therapies for NMOSD were not provided.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The reported morbidities were caused by the MS misdiagnosis.

  • It may state two separate claims as one.

    Premisecitation

    Previous data from 2 large cohort studies performed at MS tertiary care centers in 1984 and 2005 indicated that psychiatric disease and migraine were frequent final diagnoses in patients initially referred for evaluation for MS, suggesting the enduring potential for misdiagnosis in these disorders.

    “Furthermore, previous data from 2 large cohort studies performed at MS tertiary care centers in 1984 and 2005 indicated that psychiatric disease and migraine were frequent final diagnoses in patients initially referred for evaluation for MS, suggesting the enduring potential for misdiagnosis in these disorders.13,14”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Interpretationown data

    With the exception of NMOSD, diagnoses frequently mistaken for MS in this study lack a specific biomarker and their correct identification relies instead on clinical and radiographic results and the clinician's acumen alone.

    “With the exception of NMOSD, diagnoses frequently mistaken for MS in our study lack a specific biomarker and their correct identification relies instead on clinical and radiographic results and the clinician's acumen alone.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Prior authors have noted barriers to reexamining established diagnoses of MS and suggested a tendency for MS specialists, after seeing many atypical presentations of MS, to dismiss red flags as being within the spectrum of MS, rather than a clue to an alternative condition.

    “Prior authors have noted barriers to reexamining established diagnoses of MS, 4,8 and suggested a tendency for MS specialists, after seeing many atypical presentations of MS, to dismiss “red flags” as being within the spectrum of MS, rather than a clue to an alternative condition.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [8]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Interpretationreasoning

    An extensive serum laboratory evaluation may not always be helpful in the evaluation of suspect MS, as laboratory tests cannot confirm a diagnosis of fibromyalgia, migraine, or a psychogenic disorder and overreliance on imaging abnormalities may contribute to misdiagnosis in such cases.

    “This observation also suggests that an extensive serum laboratory evaluation may not always be helpful in the evaluation of suspect MS, as laboratory tests cannot confirm a diagnosis of fibromyalgia, migraine, or a psychogenic disorder and that overreliance on imaging abnormalities may contribute to misdiagnosis in such cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Study design and conductnone given

    Selection and referral bias likely influenced patient characteristics.

    “Selection and referral bias likely influenced patient characteristics.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    The assessment of some patients later in their disease course may have facilitated recognition of a misdiagnosis, and hindsight bias may have influenced opinions regarding earlier opportunity for a correct diagnosis.

    “Lastly, the assessment of some patients later in their disease course may have facilitated recognition of a misdiagnosis, and hindsight bias may have influenced opinions regarding earlier opportunity for a correct diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    Neurologists participating in the study may have been incorrect in their assessment of misdiagnosis in some cases.

    “Neurologists participating in the study may have been incorrect in their assessment of misdiagnosis in some cases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    Given the lack of specific biomarkers for the disorders mistaken for MS identified in this study, it is possible that neurologists might disagree on their assessment of the correct clinical diagnosis in some cases.

    “Given the lack of specific biomarkers for the disorders mistaken for MS identified in this study, it is possible that neurologists might disagree on their assessment of the correct clinical diagnosis in some cases.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    In 1997, Charles Poser reported on 130 misdiagnosed patients he had evaluated, with 37% disseminated encephalomyelitis, 22% chronic fatigue syndrome, 21% myelopathy, 4% posttraumatic syndrome, 4% complicated migraine, and 4% psychiatric disorders.

    “In 1997, Charles Poser reported on 130 misdiagnosed patients he had evaluated.12 His cohort contained 37% with “disseminated encephalomyelitis,” 22% with chronic fatigue syndrome, 21% with “myelopathy,” 4% with “posttraumatic syndrome,” 4% with complicated migraine, and 4% with psychiatric disorders that were misdiagnosed as MS. 12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Interpretationreasoning

    The misdiagnosis despite normal CSF may reflect a relatively higher weight given to interpretation of radiographic abnormalities in evaluation of patients for MS and the elimination of CSF consideration from the 2010 McDonald diagnostic criteria for relapsing-remitting MS.

    “perhaps a reflection of a relative higher weight given to interpretation of radiographic abnormalities in evaluation of patients for MS and the elimination of CSF consideration from the 2010 McDonald diagnostic criteria for relapsing-remitting MS.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    An estimate of the frequency of MS misdiagnosis would be desirable, but obtaining such an estimate would require a different study design.

    “An estimate of the frequency of MS misdiagnosis would be desirable, but obtaining such an estimate would require a different study design.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductreasoning

    While contributors to misdiagnosis may be inferred from available patient records and the specific alternative diagnosis identified, in most instances, our neurologists did not participate in making the initial incorrect diagnosis of MS and thus their assessment of potential contributors to misdiagnosis may be considered speculative.

    “While contributors to misdiagnosis may be inferred from available patient records and the specific alternative diagnosis identified, in most instances, our neurologists did not participate in making the initial incorrect diagnosis of MS and thus their assessment of potential contributors to misdiagnosis may be considered speculative.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationown data

    Many patients in the study carried a misdiagnosis for a lengthy period of time, including a third for 10 years or longer, and they were often exposed to unnecessary and potentially harmful treatments.

    “Many of the patients in our study carried a misdiagnosis for a lengthy period of time, including a third for 10 years or longer, and they were often exposed to unnecessary and potentially harmful treatments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    MRI demonstration of dissemination in time by current criteria may have confirmed an MS diagnosis in a number of Poser's patients.

    “MRI demonstration of dissemination in time by current criteria may have confirmed an MS diagnosis in a number of these patients.”
    Quote in the paperNot a substantial claim
25 of 25

  • The paper relies on this without support.

    The participating MS specialists accurately determined that the patients had been misdiagnosed with MS.

    “Neurologists participating in the study may have been incorrect in their assessment of misdiagnosis in some cases.”

  • The paper relies on this without support.

    The alternative diagnoses assigned by participating neurologists are correct.

    “Given the lack of specific biomarkers for the disorders mistaken for MS identified in this study, it is possible that neurologists might disagree on their assessment of the correct clinical diagnosis in some cases.”

  • The paper relies on this without support.

    The reported morbidities were caused by the MS misdiagnosis.

    “34 (31%) experienced “unnecessary morbidity as a direct result of a misdiagnosis of MS.””

  • The paper relies on this without support.

    The contributors to misdiagnosis identified by participating neurologists are valid.

    “in most instances, our neurologists did not participate in making the initial incorrect diagnosis of MS and thus their assessment of potential contributors to misdiagnosis may be considered speculative.”

  • The paper relies on this without support.

    Natalizumab is associated with progressive multifocal leukoencephalopathy.

    “Fourteen patients received natalizumab, a drug associated with progressive multifocal leukoencephalopathy.”
5 of 5

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 previous studies by the authors, when people who have MS are initially misdiagnosed, FND is often one of the conditions for which it is mistaken.

    “In several previous studies, we noticed that when people who have MS are initially misdiagnosed, FND is often one of the conditions for which it is mistaken [6]; and when people with FND are misdiagnosed, often the erroneous diagnosis is MS [7].”

    From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [6]

    The Abstract and Results describe patients incorrectly diagnosed with MS, not people with MS initially diagnosed with FND. The Abstract lists conversion or psychogenic disorders among their alternative diagnoses (12 of 110), so this source reports the reverse direction of misdiagnosis from the one attributed to it by citation [6]. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • 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 [6]

  • In a 2016 multicenter case series reporting 110 patients misdiagnosed with MS, 12 (11%) had 'conversion or psychogenic disorder', the fourth most common diagnosis.

    “In a 2016 multicenter case series reporting 110 patients misdiagnosed with MS, 12 (11%) had “conversion or psychogenic disorder”, the fourth most common diagnosis.”

    From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [6]

  • In that 2016 case series, 16 (15%) were diagnosed with fibromyalgia, and 13 (12%) with non-specific or non-localizing neurologic symptoms with abnormal MRI.

    “Also of note, 16 (15%) were diagnosed with fibromyalgia, and 13 (12%) with non-specific or non-localizing neurologic symptoms with abnormal MRI [6].”

    From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [6]

  • In one study, 31% of patients misdiagnosed with MS experienced unnecessary morbidity as a result of misdiagnosis, most commonly due to unnecessary immunomodulatory therapy and treatment side-effects.

    “In one study, 31% of patients misdiagnosed with MS experienced unnecessary morbidity as a result of misdiagnosis, most commonly due to unnecessary immunomodulatory therapy and treatment side-effects [6].”

    From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [6]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Morbidity is described as affecting at least a third of patients

    Minor

    The paper reports morbidity in 34 of 110 patients (31%), which is less than one-third, but later says at least a third experienced it.

1 of 1

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Metadata

Authors
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., Yadav, V., Whitham, R. H., Longbrake, E. E., Naismith, R. T., Wu, G. F., Parks, B. J., Wingerchuk, D. M., Rabin, B. L., Toledano, M., Tobin, W. O., Kantarci, O. H., Carter, J. L., Keegan, B. M., & Weinshenker, B. G.
Affiliations
University of Vermont (US)
ORCID
Venue
Neurology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-09-27
Volume
87
Issue
13
Pages
1393-1399
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
DOI
10.1212/wnl.0000000000003152
PMC
PMC5047038
OpenAlex
W2517920154
Semantic Scholar
295be5a49023e7c62cb7d7d7a3e7a61a71008db9
Cited by
334
References
30
Citations by year
2026: 28 · 2025: 34 · 2024: 39 · 2023: 29 · 2022: 40 · 2021: 34 · 2020: 40 · 2019: 32 · 2018: 34 · 2017: 21 · 2016: 2
FWCI
23.17
Type
journal article
Language
en
Open access
Locations
  • Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Institutes of Health (4ul1tr000448-10)
  • National Center for Advancing Translational Sciences (UL1-TR-000448)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
Keywords
multiple sclerosis, misdiagnosis, demyelinating disease, migraine, fibromyalgia, conversion disorder, psychogenic disorders, neuromyelitis optica spectrum disorder, MRI abnormalities, diagnostic criteria, disease-modifying therapy, atypical presentation
MeSH terms
Academic Medical Centers, Clinical Trials as Topic, Diagnostic Errors, Female, Humans, Male, Middle Aged, Multiple Sclerosis, United States, Biomarkers, Immunomodulation

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