Dr Patricia Coyle Outlines the Challenges of Making an Accurate MS Diagnosis

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.