“Undiagnosing” multiple sclerosis: The challenge of misdiagnosis in MS
Open accessAbstract
OBJECTIVE: To describe the clinical characteristics of encounters with patients misdiagnosed with multiple sclerosis (MS). METHODS: A cross-sectional Internet-based physician survey of MS specialists was performed. RESULTS: The response rate for the survey was 50.4%. Of those who responded, the majority (95%) reported having evaluated 1 or more patients who had been diagnosed with MS, but who they strongly felt did not have MS, within the last year. The majority of respondents (>90%) also reported the use of disease-modifying therapy in a proportion of these patients. Most respondents (94%) found clinical encounters with these patients equally or more challenging than giving a new diagnosis of MS. Fourteen percent of respondents reported that they did not always inform such patients of their opinion that they did not have MS. CONCLUSIONS: The misdiagnosis of MS is common and has significant consequences for patient care and health care system costs. Caring for a patient with a misdiagnosis of MS is challenging, and at times honest disclosure of a misdiagnosis represents an important ethical concern for neurologists. More data are needed on this patient population to improve diagnostic acumen and the care of these patients.
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Advances in MRI, serological and genetic tests have greatly helped in distinguishing MS from conditions that mimic it, but misdiagnosis can occur.
“Advances in MRI, serological and genetic tests have greatly helped in distinguishing MS from these conditions, but misdiagnosis can occur.”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [64]
The Discussion (page not provided) reports that MS specialists commonly encounter patients they believe were misdiagnosed and that improper interpretation of MRI findings may contribute. It does not establish that advances in MRI, serological, and genetic tests have greatly helped distinguish MS from mimicking conditions. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe major disorders identified that were misdiagnosed as MS were small-vessel cerebrovascular disease, migraine, fibromyalgia and functional neurological disorders.
“The major disorders identified that were misdiagnosed as MS were small-vessel cerebrovascular disease, migraine, fibromyalgia and functional neurological disorders.64”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [64]
In “Patients misdiagnosed with MS,” respondents frequently selected small-vessel ischemic disease (78.5%), migraine (50%), and fibromyalgia (31%) as suspected alternative diagnoses. Conversion disorder appears only among free-text “other” responses, so the paper does not establish functional neurological disorders as a major category. The Discussion also cautions that these selections do not represent counts of misdiagnosed patients. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn a 2012 survey of 122 MS specialists, 95% reported that they had evaluated in the last year at least one patient who they strongly felt did not have MS despite having carried a diagnosis of MS for at least a year.
“In a 2012 survey of 122 MS specialists, 95% reported that they had evaluated in the last year at least one patient who they strongly felt did not have MS despite having carried a diagnosis of MS for at least a year [29].”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [29]
When asked to recall alternate diagnoses in such misdiagnosed patients, the fourth most common disorder reported was psychiatric disorder (45%) and the sixth was fibromyalgia (31%).
“When asked to recall alternate diagnoses in such misdiagnosed patients, the fourth most common disorder reported was psychiatric disorder (45%) and the sixth was fibromyalgia (31%).”
From Functional neurological disorder and multiple sclerosis: a systematic review of misdiagnosis and clinical overlap (2022) · cites this paper as [29]
In a survey of MS specialist neurologists in the United States, 95% of respondents had seen one or more patients in the previous year who had been misdiagnosed with MS, many of whom were being treated inappropriately with disease-modifying therapies.
“In a survey of MS specialist neurologists in the United States, 95% of respondents had seen one or more patients in the previous year who had been misdiagnosed with MS, many of whom were being treated inappropriately with disease-modifying therapies.”
From Diagnosis of multiple sclerosis: progress and challenges (2017) · cites this paper as [64]
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Cites
Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
Polman, C. H., Reingold, S. C., Banwell, B., Clanet, M., Cohen, J. A., Filippi, M., Fujihara, K., Havrdova, E., Hutchinson, M., Kappos, L., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22366 · Cited by 9,802 · see citing works
Flagged first, then by citations
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- Miller DH, Weinshenker BG, Filippi M, et al. Differential diagnosis of suspected multiple sclerosis: a consensus ap- proach. Mult Scler 2008;14:1157-1174.
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- Institute of Medicine. To Err is Human; Building a Safer Health System. Washington, DC: National Academy Press; 1999.
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Cited by
Sorted by citations
Diagnosis of multiple sclerosis: progress and challenges
Brownlee, W. J., Hardy, T. A., Fazekas, F., & Miller, D. H. (2017) · The Lancet · doi:10.1016/s0140-6736(16)30959-x · Cited by 701 · see citing works
The contemporary spectrum of multiple sclerosis misdiagnosis
Solomon, A. J., Bourdette, D. N., Cross, A. H., Applebee, A., Skidd, P. M., Howard, D. B., Spain, R. I., Cameron, M. H., Kim, E., Mass, M. K., et al. (2016) · Neurology · doi:10.1212/wnl.0000000000003152 · Cited by 334 · see citing works
Self-citationIncidence of multiple sclerosis misdiagnosis in referrals to two academic centers
Kaisey, M., Solomon, A. J., Luu, M., Giesser, B. S., & Sicotte, N. L. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.01.048 · Cited by 148 · see citing works
Self-citationWalzl, D., Solomon, A. J., & Stone, J. (2022) · Journal of Neurology · doi:10.1007/s00415-021-10436-6 · Cited by 62 · see citing works
Self-citationMisdiagnosis of multiple sclerosis: Time for action
Brownlee, W. J., & Solomon, A. J. (2021) · Multiple Sclerosis Journal · doi:10.1177/13524585211005367 · Cited by 15 · see citing works
Self-citationAldraihem, M., Alyami, W., AlQahtani, E., Saeed, L., AlDosary, R., Altowaijri, G., & Almutlaq, A. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106779
- Authors
- Solomon, A. J., Klein, E. P., & Bourdette, D.
- Affiliations
- University of Vermont (US)
- Venue
- Neurology
- Published
- 2012-06-12
- Volume
- 78
- Issue
- 24
- Pages
- 1986-1991
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3369504
- OpenAlex
- W2152740112
- Cited by
- 144
- References
- 1
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 10 · 2023: 8 · 2022: 8 · 2021: 9 · 2020: 11 · 2019: 18 · 2018: 13 · 2017: 13 · 2016: 16 · 2015: 9 · 2014: 6 · 2013: 9 · 2012: 4
- FWCI
- 6.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (UL1 RR024140)
- Office of Research and Development
- National Institutes of Health (UL1TR000128, RR024140)
- Oregon Clinical and Translational Research Institute (UL1RR024140, RR024140)
- National Center for Research Resources (UL1RR024140)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- multiple sclerosis, misdiagnosis, diagnostic errors, disease-modifying therapy, patient encounters, health care costs
- MeSH terms
- Cross-Sectional Studies, Diagnostic Errors, Humans, Multiple Sclerosis, Neurology, Health Care Costs, Health Care Surveys
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