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 accessAbstract
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
Cites
Statistics
Verification
Claims the paper makes
29 Own result · 13 Sources not found · 13 Own interpretation · 6 Own method · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ CONTEMPORARY ISSUES > Abstract
boostedn = 79- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Contributors to misdiagnosis. · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fibromyalgia was reported significantly more often by Mayo Clinic neurologists than the other institutions (p 5 0.04)”
§ CONTEMPORARY ISSUES > RESULTS
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Presumed migraine-associated white matter lesions were often used to document dissemination in space imaging criteria.”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plaindirectn = 8- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the patients with migraine, neurologists specified that migrainous symptoms mistaken for demyelinating attacks were incorrectly used to satisfy dissemination in time criteria.”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 110 misdiagnosed patients, 51 (46%) were classified as “definite” and 59 (54%) “probable” misdiagnoses according to study definitions.”
- Also stated in: § RESULTS · plain
“Fifty-one patients (46%) were classified as “definite” and 59 (54%) as “probable” misdiagnoses.”
§ CONTEMPORARY ISSUES > Abstract
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The participating MS specialists accurately determined that the patients had been misdiagnosed with MS.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“34 (31%) experienced unnecessary morbidity because of misdiagnosis.”
- Also stated in: § Contributors to misdiagnosis. · plain
“34 (31%) experienced “unnecessary morbidity as a direct result of a misdiagnosis of MS.””
§ CONTEMPORARY ISSUES > Abstract
plaindirectn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: The reported morbidities were caused by the MS misdiagnosis.
- Also stated in: § Contributors to misdiagnosis. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Misdiagnosis of MS was made by a neurologist with fellowship training or a practice focus in MS in 26 patients (24%)”
- Also stated in: § Contributors to misdiagnosis. · plain
“Of note, 26 patients (24%) were misdiagnosed by neurologists with MSfocused practices”
§ CONTEMPORARY ISSUES > RESULTS
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Contributors to misdiagnosis. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, participating neurologists were sufficiently confident to inform 97% of patients that they had been misdiagnosed.”
- Also stated in: § RESULTS · plain
“Neurologists informed 107 (97%) of the patients that their MS diagnosis was incorrect.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but there were no other differences in the frequency of the other 4 most reported diagnoses among participating institutions.”
§ CONTEMPORARY ISSUES > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 18
- Probably not a substantial claim. 10
- The quote only partly states this claim. 2
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Abstract
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Contributors to misdiagnosis. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of 7 patients with NMOSD, 5 were seropositive for anti-aquaporin-4 antibodies, one was seronegative, and serostatus for one was not reported.”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plainn = 7- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“CSF was evaluated in 74 patients (67%) at the time of their initial misdiagnosis, and specific results were available for review in 52.”
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plainn = 74- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.””
§ CONTEMPORARY ISSUES > Duration of misdiagnosis
plainn = 6- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Abstract
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The alternative diagnoses assigned by participating neurologists are correct.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ CONTEMPORARY ISSUES > Abstract
plaindirectn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The contributors to misdiagnosis identified by participating neurologists are valid.
- Also stated in: § Contributors to misdiagnosis. · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“More than two-thirds of the patients were exposed to immunomodulatory therapy, almost a third for 10 years or longer.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plainn = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fourteen patients received natalizumab”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plainn = 14- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgeddirectSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The reported morbidities were caused by the MS misdiagnosis.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“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”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
What the sources say
- Not matchedcites [13]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
What the sources say
- Not matchedcites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [8]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Selection and referral bias likely influenced patient characteristics.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Neurologists participating in the study may have been incorrect in their assessment of misdiagnosis in some cases.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“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”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
What the sources say
- Not matchedcites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainn = 130- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“An estimate of the frequency of MS misdiagnosis would be desirable, but obtaining such an estimate would require a different study design.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
plaincorrelationaln = 110- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“MRI demonstration of dissemination in time by current criteria may have confirmed an MS diagnosis in a number of these patients.”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
hedgedconditionaln = 130- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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.”
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?
The cited source doesn’t support the claim as written.
In the citing paper
“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]
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The applicability of the 2010 McDonald Criteria has been reported in patients from Canada, 17 Italy, 18 the Netherlands, 19 Spain, 20 and Russia. 21”
From Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria (2018) · cites this paper as [18]
Experimental — accuracy not yet measured
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
“34 (31%) experienced "unnecessary morbidity as a direct result of a misdiagnosis of MS."”
§ CONTEMPORARY ISSUES > Contributors to misdiagnosis.
“As a result, at least a third of all patients experienced morbidity”
Citations
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
Self-citationMcDonald, 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
Self-citationNew Multiple Sclerosis Phenotypic Classification
LUBLIN, F. D. (2014) · European Neurology · doi:10.1159/000367614 · Cited by 4,277
Medical error—the third leading cause of death in the US
Makary, M. A., & Daniel, M. (2016) · BMJ · doi:10.1136/bmj.i2139 · Cited by 3,264
Improving Diagnosis in Health Care
Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, & The National Academies of Sciences, E. (2015) · doi:10.17226/21794 · Cited by 1,376
Diagnostic criteria for multiple sclerosis
Poser, C. M., & Brinar, V. V. (2001) · Clinical Neurology and Neurosurgery · doi:10.1016/s0303-8467(00)00125-6 · Cited by 1,282
Differential diagnosis of suspected multiple sclerosis: a consensus approach
Miller, D., Weinshenker, B., Filippi, M., Banwell, B., Cohen, J., Freedman, M., Galetta, S., Hutchinson, M., Johnson, R., Kappos, L., et al. (2008) · Multiple Sclerosis Journal · doi:10.1177/1352458508096878 · Cited by 642
Self-citationThe cost of multiple sclerosis drugs in the US and the pharmaceutical industry
Hartung, D. M., BOURDETTE, D. N., Ahmed, S. M., & Whitham, R. H. (2015) · Neurology · doi:10.1212/wnl.0000000000001608 · Cited by 266
Self-citationImproving Diagnosis in Health Care
(2016) · Military Medicine · doi:10.7205/milmed-d-15-00562 · Cited by 261
Goodin, D. S., Reder, A. T., Ebers, G. C., Cutter, G., Kremenchutzky, M., Oger, J., Langdon, D. W., Rametta, M., Beckmann, K., DeSimone, T. M., et al. (2012) · Neurology · doi:10.1212/wnl.0b013e3182535cf6 · Cited by 249
Cited by
Sorted by citations
Items 101–200 of 334
How much do periventricular lesions assist in distinguishing migraine with aura from CIS?
Lapucci, C., Saitta, L., Bommarito, G., Sormani, M. P., Pardini, M., Bonzano, L., Mancardi, G., Gasperini, C., Giorgio, A., Inglese, M., et al. (2019) · Neurology · doi:10.1212/wnl.0000000000007266 · Cited by 21
Preventing multiple sclerosis misdiagnosis using the “central vein sign”: A real-world study
Kaisey, M., Solomon, A. J., Guerrero, B. L., Renner, B., Fan, Z., Ayala, N., Luu, M., Diniz, M. A., Sati, P., & Sicotte, N. L. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102671 · Cited by 22
Self-citationHuang, J., Xin, B., Wang, X., Qi, Z., Dong, H., Li, K., Zhou, Y., & Lu, J. (2021) · Journal of Translational Medicine · doi:10.1186/s12967-021-03015-w · Cited by 24
Treatment Options in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders
Rommer, P. S., & Zettl, U. K. (2021) · Current Pharmaceutical Design · doi:10.2174/1381612827666210920151231 · Cited by 21
Daboul, L., O’Donnell, C. M., Cao, Q., Amin, M., Rodrigues, P., Derbyshire, J. A., Azevedo, C. J., Bar‐Or, A., Caverzasi, E., Calabresi, P. A., et al. (2022) · American Journal of Roentgenology · doi:10.2214/ajr.22.27731 · Cited by 21
Self-citationMatysiak, M., Oset, M., Domowicz, M., Gałązka, G., Namiecińska, M., & Stasiołek, M. (2023) · Biomedicines · doi:10.3390/biomedicines11020425 · Cited by 22
Gebhardt, M., Kropp, P. A., Hoffmann, F. A., et al. (2018) · European Neurology · doi:10.1159/000494092 · Cited by 21
Predicting onset of secondary-progressive multiple sclerosis using genetic and non-genetic factors
Misicka, E., Sept, C., & Briggs, F. B. S. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09850-z · Cited by 20
Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice
Sathiamoorthi, S., & Wingerchuk, D. M. (2017) · Neurology · doi:10.1212/wnl.0000000000003639 · Cited by 19
Self-citationBeyond McDonald: updated perspectives on MRI diagnosis of multiple sclerosis
Rovira, À., & Auger, C. (2021) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1957832 · Cited by 20
Wang, B., Li, X., Li, H., Xiao, L., Zhou, Z., Chen, K., Gui, L., Hou, X., Fan, R., Chen, K., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.841521 · Cited by 21
Marco, R. D., Greco, A., Calonghi, N., Dattoli, S. D., Baiula, M., Spampinato, S. M., Picchetti, P., Cola, L. D., Anselmi, M., Cipriani, F., et al. (2017) · Peptide Science · doi:10.1002/bip.23081 · Cited by 20
Misdiagnosis of multiple sclerosis
Brownlee, W. J. (2018) · Neurology · doi:10.1212/wnl.0000000000006584 · Cited by 19
“However, the conditions most often mistaken for MS are commons ones—migraine, fibromyalgia, and functional neurologic disorders, typically whenMRI scans done to investigate these problems disclose white matter lesions.(1) Misdiagnosis of MS can have serious implications: patients may be exposed to the risks of MS dise…”
BackgroundInfluentialDiagnosis of multiple sclerosis through the lens of ultra-high-field MRI
Sati, P. (2018) · Journal of Magnetic Resonance · doi:10.1016/j.jmr.2018.01.022 · Cited by 20
Probert, F., Yeo, T., Zhou, Y., Sealey, M. A., Arora, S., Palace, J. A., Claridge, T. D. W., Hillenbrand, R., Oechtering, J., Kühle, J., et al. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2021.811351 · Cited by 19
Iljicsov, A., Milanovich, D., Ajtay, A., Oberfrank, F., Bálint, M., Dobi, B., Bereczki, D., & Simó, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0236432 · Cited by 20
Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis
Tillema, J., Weigand, S. D., Dayan, M., Shu, Y., Kantarci, O. H., Lucchinetti, C. F., & Port, J. D. (2018) · American Journal of Neuroradiology · doi:10.3174/ajnr.a5636 · Cited by 20
Self-citationWang, Y., Rjeily, N. B., Koshorek, J., Grkovski, R., Aulakh, M., Lin, D. D. M., Solomon, A. J., & Mowry, E. M. (2023) · Multiple Sclerosis Journal · doi:10.1177/13524585231196795 · Cited by 20
“322 Black 52 (18) 4 (10) Asian/Pacific Islander 6 (2) 1 (2) Other 32 (12) 3 (7) Hispanic or Latino, n (%) 8 (3) 0 (0) 0.”
BackgroundInfluentialSelf-citationMoog, T. M., McCreary, M., Wilson, A., Stanley, T., Yu, F. F., Pinho, M. C., Guo, X., & Okuda, D. T. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11089-9 · Cited by 17
Clinical trials in multiple sclerosis: potential future trial designs
Manouchehri, N., Zhang, Y., Salter, A. R., Hussain, R. Z., Hartung, H.-P., Hemmer, B., Linker, R. A., Segal, B. M., Cutter, G., & Stüve, O. (2019) · Therapeutic Advances in Neurological Disorders · doi:10.1177/1756286419847095 · Cited by 17
Salazar, I. L., Lourenço, A. S., Manadas, B. J., Baldeiras, I., Ferreira, C., Teixeira, A. C., Mendes, V. M., Novo, A. M., Machado, R., Batista, S., et al. (2022) · Journal of Neuroinflammation · doi:10.1186/s12974-022-02404-2 · Cited by 17
Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature
Chiang, H., Khera, A., Stopschinski, B. E., Stüve, O., Hart, J., Kelley, B. J., & Nguyen, T. P. (2022) · Geriatrics · doi:10.3390/geriatrics7030061 · Cited by 16
“, periventricular hyperintensities) due to small-vessel disease may be mistaken for MS demyelination if not cautiously interpreted, leading to misdiagnosis of MS [71,72]; on the other hand, confluent demyelinating lesions due to MS can resemble the appearance of small-vessel ischemic disease [72].”
BackgroundMisdiagnosis of multiple sclerosis: Time for action
Brownlee, W. J., & Solomon, A. J. (2021) · Multiple Sclerosis Journal · doi:10.1177/13524585211005367 · Cited by 15
Self-citationAnomalies Characteristic of Central Nervous System Demyelination
Lebrun‐Frénay, C., Kantarci, O. H., Sıva, A., Pelletier, D., & Okuda, D. T. (2017) · Neurologic Clinics · doi:10.1016/j.ncl.2017.08.004 · Cited by 15
Self-citationSivakolundu, D. K., Hansen, M. R., West, K. L., Wang, Y., Stanley, T., Wilson, A., McCreary, M., Turner, M. P., Pinho, M. C., Newton, B. D., et al. (2019) · Journal of Neuroimaging · doi:10.1111/jon.12633 · Cited by 15
New imaging approaches for precision diagnosis and disease staging of MS?
Oh, J., & Sicotte, N. L. (2020) · Multiple Sclerosis Journal · doi:10.1177/1352458519871817 · Cited by 14
Sivakolundu, D. K., West, K. L., Zuppichini, M. D., Wilson, A., Moog, T. M., Blinn, A. P., Newton, B. D., Wang, Y., Stanley, T., Guo, X., et al. (2020) · Journal of Neurology · doi:10.1007/s00415-020-09923-z · Cited by 16
Advanced MRI Methods for Diagnosis and Monitoring of Multiple Sclerosis ( MS )
Elahi, R., Taremi, S., Najafi, A., Karimi, H., Asadollahzadeh, E., Sajedi, S. A., Rad, H. S., & Sahraian, M. A. (2025) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.29817 · Cited by 17
Esposito, J. E., Annoni, G., D’Amato, M., Graziosi, A., Troilo, F., Risio, A. D., Angelini, G., Castiglione, C., Tocco, P., Volpe, P., et al. (2024) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2302035 · Cited by 14
Improving criteria for dissemination in space in multiple sclerosis by including additional regions
Foster, M. A., Pontillo, G., Davagnanam, I., Collorone, S., Prados, F., Kanber, B., Yiannakas, M. C., Ogunbowale, L., Burke, A., Wheeler‐Kingshott, C. A. M. G., et al. (2024) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.52170 · Cited by 15
Migraine as possible red flag of PFO presence in suspected demyelinating disease
Signoriello, E., Cirillo, M., Puoti, G., Signoriello, G., Negro, A. D., Koci, E., Melone, M. A. B., Rapacciuolo, A., Maresca, G., & Lus, G. (2018) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2018.04.042 · Cited by 15
Applying the 2017 McDonald diagnostic criteria for multiple sclerosis
Rommer, P. S., & Zettl, U. K. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(18)30161-3 · Cited by 15
Conventional and advanced MRI in multiple sclerosis
Louapre, C. (2018) · Revue Neurologique · doi:10.1016/j.neurol.2018.03.009 · Cited by 16
“In a recent multicenter study of 110 misdiagnosed patients, the main alternative diagnosis of MS was migraine (22%), a condition associated with WM hyperintensities and subclinical brain infarcts [6].”
BackgroundDefining Benign/Burnt-Out MS and Discontinuing Disease-Modifying Therapies
McFaul, D., Hakopian, N. N., Smith, J. B., Nielsen, A. S., & Langer-Gould, A. M. (2021) · Neurology Neuroimmunology & Neuroinflammation · doi:10.1212/nxi.0000000000000960 · Cited by 14
Jendretzky, K. F., Bajor, A., Lezius, L.-M., Hümmert, M. W., Konen, F. F., Große, G. M., Schwenkenbecher, P., Sühs, K., Trebst, C., Framme, C., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-57199-4 · Cited by 14
Filippi, M., Preziosa, P., Margoni, M., & Rocca, M. A. (2024) · Neuroimaging Clinics of North America · doi:10.1016/j.nic.2024.03.001 · Cited by 15
Use (and misuse) of the McDonald criteria to diagnose multiple sclerosis
Brownlee, W. J. (2017) · European Journal of Neurology · doi:10.1111/ene.13501 · Cited by 13
“objective evidence of a lesion as major contributors to MS misdiagnosis and mistreatment [6].”
BackgroundRecent advances in development of nanomedicines for multiple sclerosis diagnosis
Zhang, Q., Dai, X., Zhang, H., Zeng, Y., Luo, K., & Li, W. (2021) · Biomedical Materials · doi:10.1088/1748-605x/abddf4 · Cited by 13
Application of deep-learning to the seronegative side of the NMO spectrum
Cacciaguerra, L., Storelli, L., Radaelli, M., Mesaroš, Š., Moiola, L., Drulovic, J. S., Filippi, M., & Rocca, M. A. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10727-y · Cited by 13
Tumefactive demyelinating lesions: A literature review of recent findings
Malik, Y. M. A. (2024) · Neurosciences · doi:10.17712/nsj.2024.3.20230111 · Cited by 17
Vaccarino, F., Quattrocchi, C. C., & Parillo, M. (2025) · Bioengineering · doi:10.3390/bioengineering12050473 · Cited by 14
Precision medicine for multiple sclerosis promotes preventative medicine
Hansen, M. R., & Okuda, D. T. (2018) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13846 · Cited by 12
Investigation of the “central vein sign” in infratentorial multiple sclerosis lesions
Weber, C. E., Sandikci, V., Ebert, A., Szabo, K., Platten, M., Gass, A., & Eisele, P. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102409 · Cited by 14
Calabrese, M., Marastoni, D., Crescenzo, F., & Scalfari, A. (2021) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000921 · Cited by 12
miR-24-3p and miR-484 are potential biomarkers for neurodegeneration in multiple sclerosis
Al-Temaimi, R. A., & Alroughani, R. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e32685 · Cited by 11
“Despite ongoing refinement of the diagnostic criteria for MS, diagnosing MS is still hard to ascertain, and MS misdiagnoses are estimated to range between 30 and 67 % in different healthcare centers [1,2].”
BackgroundInvestigating Whether Dissemination in Time Is Essential to Diagnose Relapsing Multiple Sclerosis
Brownlee, W. J., Foster, M. A., Pontillo, G., Davagnanam, I., Collorone, S., Prados, F., Kanber, B., Barkhof, F., Thompson, A. J., Toosy, A., et al. (2025) · Neurology · doi:10.1212/wnl.0000000000210274 · Cited by 13
McArdle Sign: A Specific Sign of Multiple Sclerosis
Savoldi, F., Nasr, Z., Hu, W., Schilaty, N. D., Delgado, A. M., Mandrekar, J. N., Kaufman, K. R., Berglund, L. J., & Weinshenker, B. G. (2019) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2019.01.047 · Cited by 11
Self-citationJendretzky, K. F., Lezius, L.-M., Thiele, T., Konen, F. F., Huss, A. M., Heitmann, L., Güzeloglu, Y. E., Schwenkenbecher, P., Sühs, K., Škuljec, J., et al. (2024) · Neurological Research and Practice · doi:10.1186/s42466-024-00351-2 · Cited by 12
Confirming a Historical Diagnosis of Multiple Sclerosis
Solomon, A. J., Arrambide, G., Brownlee, W. J., Cross, A. H., Gaitán, M. I., LUBLIN, F. D., Makhani, N., Mowry, E. M., Reich, D. S., Rovira, À., et al. (2022) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000001149 · Cited by 10
Self-citationTieppo, 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
Shi, L., Ghezzi, L., Fenoglio, C., Pietroboni, A. M., Galimberti, D., Pace, F., Hardy, T. A., Piccio, L. M., & Don, A. S. (2024) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2024-333774 · Cited by 11
Rath, J., Foesleitner, O., Haider, L., Bickel, H., Leutmezer, F., Polanec, S. H., Arnoldner, M. A., Sunder–Plassmann, G., Prayer, D., Berger, T., et al. (2022) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-022-02187-y · Cited by 9
MRI features and disability in multiple sclerosis: A systematic review and meta-analysis
Nabizadeh, F., Zafari, R., Mohamadi, M., Maleki, T., Fallahi, M. S., & Rafiei, N. (2024) · Journal of Neuroradiology · doi:10.1016/j.neurad.2023.11.007 · Cited by 13
Disease Modifying Strategies in Multiple Sclerosis: New Rays of Hope to Combat Disability?
Bellanca, C. M., Augello, E., Mariottini, A., Bonaventura, G., Cognata, V. L., Benedetto, G. D., Cantone, A. F., Attaguile, G. A., Mauro, R. D., Cantarella, G., et al. (2024) · Current Neuropharmacology · doi:10.2174/1570159x22666240124114126 · Cited by 10
“…diagnostic criteria and the pressure due to anticipation of the diagnosis for early treat-ment administration is determining a high MS misdiagnosis rate, to date estimated about 15% of cases, with subsequent inappropriate DMTs administration in patients carrying pathologies different from MS [55].”
BackgroundManning, A. R., Letchuman, V., Martin, M. L., et al. (2024) · American Journal of Neuroradiology · doi:10.3174/ajnr.a8510 · Cited by 9
Self-citationClinicians and Cognitive Bias: A Case of Frontotemporal Dementia Misdiagnosed as Conversion Disorder
Braus, B. R., Rummans, T. A., Lapid, M. I., Morgan, R. J., Sampson, S. M., Handler, E. M., & Dimsdale, J. E. (2019) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18050551 · Cited by 9
Lane, M., & Yadav, V. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-43044-9.00199-0 · Cited by 11
Self-citationvan Rensburg, S. J., van Toorn, R., Erasmus, R. T., Hattingh, C. J., Johannes, C., Moremi, K. E., Kemp, M. C., Engel-Hills, P. C., & Kotze, M. J. (2021) · Metabolic Brain Disease · doi:10.1007/s11011-021-00711-w · Cited by 9
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
Typical and Emerging Diagnostic MRI Features in Multiple Sclerosis
Rovira, À., Auger, C., Sceppacuercia, S., & Torres, C. (2024) · Canadian Association of Radiologists Journal · doi:10.1177/08465371241261847 · Cited by 10
Rabin, A. R., Bello, E., Kumar, S., Zeki, D. A., Afshari, K., Deshpande, M., Francis, N., Khalighinejad, F., Umeton, R. P., Radu, I., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-67769-1 · Cited by 9
McDonald criteria application by German neurologists suggests a need for further training
Heinemann, J., Yankov, D., Solomon, A. J., Rauer, S., Wiendl, H., & Dersch, R. S. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106304 · Cited by 8
Self-citationIncorporation of the central vein sign into the McDonald criteria
Amin, M., Nakamura, K., Daboul, L., O’Donnell, C. M., Cao, Q., Rodrigues, P., Derbyshire, J. A., Azevedo, C. J., Bar‐Or, A., Caverzasi, E., et al. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.106182 · Cited by 10
Self-citationConsensus recommendations on multiple sclerosis management in Australia and New Zealand: part 1
Shipley, J., Beharry, J., Yeh, W. Z., Seery, N., Foong, Y. C., Ayton, D., Siriratnam, P., Tan, T., Beadnall, H. N., Barton, J., et al. (2025) · The Medical Journal of Australia · doi:10.5694/mja2.52578 · Cited by 10
Current and future applications of artificial intelligence in multiple sclerosis
Cacciaguerra, L., Storelli, L., Rocca, M. A., & Filippi, M. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-90037-9.00012-6 · Cited by 8
Levasseur, V. A., Xiang, B., Salter, A. R., et al. (2022) · Journal of Central Nervous System Disease · doi:10.1177/11795735221084842 · Cited by 8
Self-citationMisdiagnosis of Multiple Sclerosis: Past, Present, and Future
Rjeily, N. B., & Solomon, A. J. (2024) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-024-01371-w · Cited by 10
“Numerous studies have shown that over half of the misdiagnosed patients had been initiated on MS DMT prior to diagnostic re-evaluation [10, 21–25 , 27].”
InfluentialSelf-citationHuang, Y. T., Giacomini, P. S., Massie, R., et al. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.928493 · Cited by 7
Self-citationHeadache in Multiple Sclerosis: A Narrative Review
Adamczyk, B., Morawiec, N., Boczek, S., Dańda, K., Herba, M., Spyra, A., Sowa, A., Szczygieł, J., & Adamczyk-Sowa, M. H. (2024) · Medicina · doi:10.3390/medicina60040572 · Cited by 7
“Presumed migraine-associated white matter lesions were used to document dissemination in space criteria [55].”
MethodTobin, W. O. (2021) · Neurology · doi:10.1212/wnl.0000000000012738 · Cited by 7
Self-citationShafquat, A., Crystal, R. G., & Mezey, J. G. (2020) · BMC Bioinformatics · doi:10.1186/s12859-020-3387-z · Cited by 8
“As another example, patients with migraine, fibromyalgia, and psychogenic disorder may frequently be misdiagnosed with multiple sclerosis due to overlap of symptoms and mistakes in application of clinical and radiographic diagnostic criteria [65].”
BackgroundCentral vein sign in multiple sclerosis
Miller, A., & Calabresi, P. A. (2018) · Neurology · doi:10.1212/wnl.0000000000005241 · Cited by 7
Ivaniuk, A., Marusich, T., Solodovnikova, Y., & Son, A. (2020) · Medicina · doi:10.3390/medicina56040170 · Cited by 8
“While other disorders are more often initially diagnosed as MS in high-income countries [6], the opposite problem may be particularly relevant to low-income countries, especially for rural sites with limited access to healthcare professionals and corresponding diagnostic procedures.”
BackgroundInfluentialDissemination in time as a requirement for diagnosis of multiple sclerosis: Time for a change?
Miller, A. (2024) · Multiple Sclerosis Journal · doi:10.1177/13524585241233999 · Cited by 7
Vieira, G. D. D., Antônio, F. F., & Damasceno, A. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105867 · Cited by 6
Aybek, S., & Chan, A. (2022) · European Journal of Neurology · doi:10.1111/ene.15568 · Cited by 6
Landes-Château, C., Levraut, M., Cohen, M., Sicard, M., Papeix, C., Cotton, F., Balcerac, A., Themelin, A., Mondot, L., & Lebrun‐Frénay, C. (2023) · Revue Neurologique · doi:10.1016/j.neurol.2023.04.006 · Cited by 8
Radiologically isolated syndrome should be treated with disease-modifying therapy – Commentary
Lebrun‐Frénay, C. (2017) · Multiple Sclerosis Journal · doi:10.1177/1352458517727149 · Cited by 6
Rae-Grant, A. D. (2019) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000726 · Cited by 7
Employment status of people diagnosed with multiple sclerosis in Brazil
Estrutti, C. M., Cardoso, G. S. M. E., de Novais, M. A. P., et al. (2019) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20190051 · Cited by 6
Avasarala, J., Pettigrew, L. C., Sutton, P., Guduru, Z., Gurwell, J. A., Sokola, B. S., & Mullins, S. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.101949 · Cited by 6
Kopfschmerzen bei Multipler Sklerose
Gebhardt, M., Kropp, P. A., Hoffmann, F. A., & Zettl, U. K. (2020) · Der Nervenarzt · doi:10.1007/s00115-020-00959-0 · Cited by 7
Newly diagnosed multiple sclerosis in a patient with ocular myasthenia gravis
Bong, J. B., Lee, M. A., & Kang, H. G. (2022) · Medicine · doi:10.1097/md.0000000000028887 · Cited by 6
“Strict diagnostic criteria should be implemented when diagnosing multiple sclerosis to avoid misdiagnosis, which is reportedly 25% in the United States.”
BackgroundDifferential diagnosis of multiple sclerosis
Brownlee, W. J. (2019) · Neurology · doi:10.1212/wnl.0000000000007566 · Cited by 6
“Antinuclear antibodies, for example, are frequently found in people withMS at low ormoderate titers, and are rarely of any clinical importance unless a patient has systemic symptoms pointing to an underlying connective tissue disorder.8 Overall, Calabrese et al. provide a useful insight into the spectrum of alternativ…”
BackgroundInfluentialShah, A. A., Piche, J., Stewart, B., et al. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104443 · Cited by 5
Self-citationPrevalence of fibromyalgia in a Brazilian series of patients with multiple sclerosis
Thomas, C., Schneider, B. T., Verza, C. S., Fassina, G. S., Weber, L. R., Moreira, M., Fusinato, P. T., & Forcelini, C. M. (2023) · Arquivos de Neuro-Psiquiatria · doi:10.1055/s-0043-1772673 · Cited by 5
Iris, F., Béopoulos, A., & Géa, M. (2018) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2018.07.005 · Cited by 5
Is multiple sclerosis overdiagnosed?
Hawkes, C. H., Giovannoni, G., Lechner‐Scott, J., Levy, M., & Pohl, D. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102721 · Cited by 5
Radiologically isolated syndrome: from biological bases to practical management
Barboza, A. G., Contentti, E. C., Curbelo, M. C., Halfón, M. J., Rojas, J. I., Silva, B. A., Sinay, V. J., Tizio, S., Ysrraelit, M. C., & Alonso, R. N. (2021) · Neurological Sciences · doi:10.1007/s10072-021-05069-6 · Cited by 6
Zamalloa, C. C., Castro‐Suárez, S., Cortez-Escalante, J., Aguirre-Quispe, W., Guevara‐Silva, E. A., Osorio-Marcatinco, V., & Meza-Vega, M. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e08069 · Cited by 5
Alonso, R. N., Eizaguirre, M. B., López, P. A., Silva, B. A., Rojas, J. I., Sinay, V. J., Tkachuk, V. A., Patrucco, L., Carrá, A., Bruno, D., et al. (2022) · Neurological Sciences · doi:10.1007/s10072-022-06471-4 · Cited by 5
Multiple Sclerosis in Korea: A Hospital-Based, Multicenter, Epidemiological Study
Kim, S., Lee, E., Min, J., Kim, S., Shin, H. Y., Kwon, Y. N., Kim, W., Oh, J., Kim, J. S., Baek, S., et al. (2023) · Journal of Multiple Sclerosis and Neuroimmunology · doi:10.59578/jmsni.2023.14.1.51 · Cited by 5
Real‐world challenges in the diagnosis of primary progressive multiple sclerosis
Blok, K. M., Smolders, J., van Rosmalen, J., Jarnalo, C. O. M., Wokke, B. H. A., & de Beukelaar, J. (2023) · European Journal of Neurology · doi:10.1111/ene.16042 · Cited by 5
Alam, Z., Maddali, A., Patel, S., Weber, N., Rikabi, S. A., Thiemann, D., Desai, K., & Monoky, D. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13253-3 · Cited by 5
“Furthermore, the psychological and social implications of misdiagnosing a chronic condition like MS can also weigh heavily on patients, potentially leading to unnecessary anxiety, disability, or financial strain [31, 32].”
Hu, F., Ren, Z., Chen, L., Valcarcel, A. M., Dworkin, J. D., Renner, B., Daboul, L., O’Donnell, C. M., Verter, E., Manning, A. R., et al. (2025) · Imaging Neuroscience · doi:10.1162/imag.a.932 · Cited by 4
Self-citationFunctional Limb Weakness and Paralysis
Aybek, S. (2022) · Current clinical neurology · doi:10.1007/978-3-030-86495-8_5 · Cited by 4
Differentiation of MS lesions through analysis of microvascular distribution
Sundvall, L., Mikkelsen, I. K., Eskildsen, S. F., Hjørringgaard, M. M., Nygaard, M. K. E., Rasmussen, P. V., Petersen, T., & Østergaard, L. (2024) · Imaging Neuroscience · doi:10.1162/imag_a_00357 · Cited by 4
Vilaseca, A., Tintoré, M., Carbonell‐Mirabent, P., Rodríguez, M., Arévalo, M. J., Ariño, H., Auger, C., Bollo, L., Carvajal, R., Castilló, J., et al. (2025) · Multiple Sclerosis Journal · doi:10.1177/13524585251314749 · Cited by 5
Li, J., Huang, W., Luo, X., et al. (2021) · Journal of Neuroimaging · doi:10.1111/jon.12938 · Cited by 4
Multiple Sclerosis: Systemic Challenges to Cost-Effective Care.
Weinstein, D. R., Owens, G. M., & Gandhi, A. M. (2022) · PubMed · Cited by 5
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
- Solomon, Andrew J.
- Bourdette, Dennis N.
- Cross, Anne H.
- Spain, Rebecca I.
- Cameron, Michelle H.
- Kim, Edward
- Yadav, Vijayshree
- Longbrake, Erin E.
- Naismith, Robert T.
- Wu, Gregory F.
- Parks, Becky J.
- Wingerchuk, Dean M.
- Toledano, Michel
- Tobin, W. Oliver
- Kantarci, Orhun H.
- Carter, Jonathan L.
- Keegan, B. Mark
- Weinshenker, Brian G.
- Venue
- Neurology
- Published
- 2016-09-27
- Volume
- 87
- Issue
- 13
- Pages
- 1393-1399
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- 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
- bronze
- doi.org
- 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
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.
A language model drew the claims from the paper on 2026-10-23, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-23 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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
