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.
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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
Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria
Thompson, A. J., Banwell, B. L., Barkhof, F., Carroll, W. M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M. S., et al. (2018) · The Lancet Neurology · doi:10.1016/s1474-4422(17)30470-2 · Cited by 8,167
Self-citationReich, D. S., Lucchinetti, C. F., & Calabresi, P. A. (2018) · New England Journal of Medicine · doi:10.1056/nejmra1401483 · Cited by 2,491
Thompson, A. J., Baranzini, S. E., Geurts, J. J. G., Hemmer, B., & Ciccarelli, O. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30481-1 · Cited by 1,979
Filippi, M., Bar-Or, A., Piehl, F., Preziosa, P., Solari, A., Vukusic, S., & Rocca, M. A. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0041-4 · Cited by 1,562
Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines
Filippi, M., Preziosa, P., Banwell, B., Barkhof, F., Ciccarelli, O., Stefano, N. D., Geurts, J. J. G., Paul, F., Reich, D. S., Toosy, A., et al. (2019) · Brain · doi:10.1093/brain/awz144 · Cited by 609
Self-citation
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 ›
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