There is a push to diagnose multiple sclerosis (MS) earlier, which can lead to misdiagnosis if the diagnostic criteria aren’t used properly, explained Patricia K. Coyle, MD, director of the MS Comprehensive Care Center and professor of neurology at Stony Brook University Neurosciences Institute.
There is a push to diagnose multiple sclerosis (MS) earlier, which can lead to misdiagnosis if the diagnostic criteria aren’t used properly. As a result, some people are being told they have MS, when they actually don’t, explained Patricia K. Coyle, MD, director of the MS Comprehensive Care Center and professor of neurology at Stony Brook University Neurosciences Institute.
What are some of the diagnostic issues that could make it difficult to make an accurate diagnosis of multiple sclerosis?
Well, first of all, there's a push to diagnose very early so appropriate treatment can be used. Secondly, there's not a good understanding of the 2017 revised McDonald diagnostic criteria, which are the formal diagnostic criteria. They're actually quite useful. I think they're quite easy to understand. We need to be using them on a regular basis.
Thirdly, there is a true misdiagnosis rate. So, the diagnostic criteria are not being applied. And I think this argues for a very robust workup and being aware that people are being told they have MS and they don't, and there's actually some harm being done. So, I think the diagnosis everything starts with diagnosis, and we need to take it very seriously.
How can providers better overcome diagnostic issues to make an earlier diagnosis of multiple sclerosis?
One key is a thorough, robust workup. That means you create a differential diagnosis; you do appropriate bloodwork. For example, anyone who is presenting with possible relapsing ms, I believe you need to check them for IgG [immunoglobulin] to aquaporin-4 in the blood. You need to check them to for IgG to MOG [myelin oligodendrocyte glycoprotein] in the blood to rule out seropositive NMO [neuromyelitis optica] spectrum disorder, and MOGAD—MOG-associated disorders. That should be routinely done.
We need a robust workup. They need MRI imaging, not just of the brain, but I believe of the cervical and the thoracic spinal cord, the other part of the central nervous system, actually imaging down to the conus.
And thirdly, our center routinely lumbar punctures. We look at cerebral spinal fluid. We're looking for CSF [cerebral spinal fluid] oligoclonal band specificity. That's independent of the MRI pattern. It is extraordinarily helpful to assure that you have MS and not another diagnosis. So, I think a thorough workup laboratory evaluation is key.
ATS 2024: Bridging the Past, Present, and Future of Respiratory Care
May 16th 2024The application of artificial intelligence in medicine is anticipated as a highlight of ATS 2024, with sessions exploring its applications in research, radiological interpretation, and pediatric pulmonology.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Posters Characterize DMD Caregiver Experiences, Impact of Gene Therapy on Caregiving Demands
May 10th 2024Posters presented at the ISPOR—The Professional Society for Health Economics and Outcomes Research meeting explored Duchenne muscular dystrophy (DMD) caregiver experiences and gene therapy’s impact on work opportunities for caregivers.
Read More