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Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ. Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024; 271:1497-1514. [PMID: 37864717 PMCID: PMC10972995 DOI: 10.1007/s00415-023-12021-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
IMPORTANCE Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS. OBSERVATIONS Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches. CONCLUSIONS AND RELEVANCE There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.
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Affiliation(s)
- Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kottil Rammohan
- Division of Multiple Sclerosis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
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Landes-Chateau C, Levraut M, Okuda DT, Themelin A, Cohen M, Kantarci OH, Siva A, Pelletier D, Mondot L, Lebrun-Frenay C. The diagnostic value of the central vein sign in radiologically isolated syndrome. Ann Clin Transl Neurol 2024; 11:662-672. [PMID: 38186317 DOI: 10.1002/acn3.51986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE The radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS). Increasing evidence suggests that the central vein sign (CVS) enhances lesion specificity, allowing for greater MS diagnostic accuracy. This study evaluated the diagnostic performance of the CVS in RIS. METHODS Patients were prospectively recruited in a single tertiary center for MS care. Participants with RIS were included and compared to a control group of sex and age-matched subjects. All participants underwent 3 Tesla magnetic resonance imaging, including postcontrast susceptibility-based sequences, and the presence of CVS was analyzed. Sensitivity and specificity were assessed for different CVS lesion criteria, defined by proportions of lesions positive for CVS (CVS+) or by the absolute number of CVS+ lesions. RESULTS 180 participants (45 RIS, 45 MS, 90 non-MS) were included, representing 5285 white matter lesions. Among them, 4608 were eligible for the CVS assessment (970 in RIS, 1378 in MS, and 2260 in non-MS). According to independent ROC comparisons, the proportion of CVS+ lesions performed similarly in diagnosing RIS from non-MS than MS from non-MS (p = 0.837). When a 6-lesion CVS+ threshold was applied, RIS lesions could be diagnosed with an accuracy of 87%. MS could be diagnosed with a sensitivity of 98% and a specificity of 83%. Adding OCBs or Kappa index to CVS biomarker increased the specificity to 100% for RIS diagnosis. INTERPRETATION This study shows evidence that CVS is an effective imaging biomarker in differentiating RIS from non-MS, with similar performances to those in MS.
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Affiliation(s)
| | - Michael Levraut
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Médecine Interne, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 1, Nice, France
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Albert Themelin
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Mikael Cohen
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Neurologie, Centre de Ressource et de Compétence Sclérose en Plaques (CRC-SEP), Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | | | - Aksel Siva
- Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | - Lydiane Mondot
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
| | - Christine Lebrun-Frenay
- Université Cote d'Azur, UMR2CA (URRIS), Nice, France
- Service de Neurologie, Centre de Ressource et de Compétence Sclérose en Plaques (CRC-SEP), Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, Nice, France
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Kaisey M, Solomon AJ. Multiple Sclerosis Diagnostic Delay and Misdiagnosis. Neurol Clin 2024; 42:1-13. [PMID: 37980109 DOI: 10.1016/j.ncl.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Multiple sclerosis (MS) misdiagnosis in the form of an incorrect diagnosis of MS, as well as delayed diagnosis in patients who do have MS, both influence patient clinical outcomes. Contemporary studies have reported data on factors associated with these diagnostic challenges and their frequency. Expediting diagnosis in patients with MS and reducing MS misdiagnosis in patients who do not have MS may be aided by educational efforts surrounding early MS symptoms and proper application of MS diagnostic criteria. Emerging novel MS diagnostic biomarkers may aid early and accurate diagnosis of MS in the future.
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Affiliation(s)
- Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A6600, Los Angeles, CA 90048, USA.
| | - Andrew J Solomon
- Department of Neurological Sciences, University of Vermont, Larner College of Medicine, University Health Center, Arnold 2, 1 South Prospect Street, Burlington, VT 05401, USA
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4
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Landes-Chateau C, Levraut M, Cohen M, Sicard M, Papeix C, Cotton F, Balcerac A, Themelin A, Mondot L, Lebrun-Frenay C. Identification of demyelinating lesions and application of McDonald criteria when confronted with white matter lesions on brain MRI. Rev Neurol (Paris) 2023; 179:1103-1110. [PMID: 37730469 DOI: 10.1016/j.neurol.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION White matter lesions (WML) on magnetic resonance imaging (MRI) are common in clinical practice. When analyzing WML, radiologists sometimes propose a pathophysiological mechanism to explain the observed MRI abnormalities, which can be a source of anxiety for patients. In some cases, discordance may appear between the patient's clinical symptoms and the identification of the MRI-appearing WML, leading to extensive diagnostic work-up. To avoid misdiagnosis, the analysis of WML should be standardized, and a consensual MRI reading approach is needed. OBJECTIVE To analyze the MRI WML identification process, associated diagnosis approach, and misinterpretations in physicians involved in WML routine practice. METHODS Through a survey distributed online to practitioners involved in WML diagnostic work-up, we described the leading causes of MRI expertise misdiagnosis and associated factors: clinical experience, physicians' subspecialty and location of practice, and type of device used to complete the survey. The survey consisted of sixteen T2-weighted images MRI analysis, from which ten were guided (binary response to lesion location identification), four were not shown (multiple possible answers), and two were associated with dissemination in space (DIS) McDonald criteria application. Two independent, experienced practitioners determined the correct answers before the participants' completion. RESULTS In total, 364 participants from the French Neuro Radiological (SFNR), French Neurological (SFN), and French Multiple Sclerosis (SFSEP) societies completed the survey entirely. According to lesion identification, 34.3% and 16.9% of the participants correctly identified juxtacortical and periventricular lesions, respectively, whereas 56.3% correctly identified non-guided lesions. Application of the 2017 McDonald's DIS criteria was correct for 35.3% of the participants. According to the global survey scoring, factors independently associated with correct answers in multivariate analysis were MS-expert subspecialty (P<0.001), young clinical practitioners (P=0.02), and the use of a computer instead of a smartphone to perform WML analysis (P=0.03). CONCLUSION Our results highlight the difficulties regarding WML analysis in clinical practice and suggest that radiologists and neurologists should rely on each other to ensure the diagnosis of multiple sclerosis and related disorders and limit misdiagnoses.
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Affiliation(s)
- C Landes-Chateau
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France.
| | - M Levraut
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - M Cohen
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - M Sicard
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - C Papeix
- Service de neurologie générale, hôpital Fondation Adolphe-de-Rothschild, Paris, France
| | - F Cotton
- U1044 Inserm, CREATIS, UMR 5220 CNRS, service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard Lyon, Lyon, France
| | - A Balcerac
- Département de neurologie, université la Sorbonne, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Themelin
- Service de radiologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - L Mondot
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
| | - C Lebrun-Frenay
- UR2CA-URRIS, CRCSEP neurologie, CHU de Nice, université Côte d'Azur, Nice, France
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5
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Wang Y, Bou Rjeily N, Koshorek J, Grkovski R, Aulakh M, Lin D, Solomon AJ, Mowry EM. Clinical and radiologic characteristics associated with multiple sclerosis misdiagnosis at a tertiary referral center in the United States. Mult Scler 2023; 29:1428-1436. [PMID: 37698023 DOI: 10.1177/13524585231196795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Misdiagnosis of multiple sclerosis (MS) is common and can have harmful effects on patients and healthcare systems. Identification of factors associated with misdiagnosis may aid development of prevention strategies. OBJECTIVE To identify clinical and radiological predictors of MS misdiagnosis. METHODS We retrospectively reviewed medical records of all patients who were referred to Johns Hopkins MS Center from January 2018 to June 2019. Patients who carried a diagnosis of MS were classified as correctly diagnosed or misdiagnosed with MS by the Johns Hopkins clinician. Demographics, clinical, laboratory, and radiologic data were collected. Differences between the two groups were evaluated, and a regression model was constructed to identify predictors of misdiagnosis. RESULTS Out of 338 patients who were previously diagnosed with MS, 41 (12%) had been misdiagnosed. An alternative diagnosis was confirmed in 28 (68%) of the misdiagnosed patients; cerebrovascular disease was the most common alternate diagnosis. Characteristics associated with misdiagnosis were female sex (odds ratio (OR): 5.81 (95% confidence interval (CI): 1.60, 21.05)) and non-specific brain magnetic resonance imaging (MRI) lesions (OR: 7.66 (3.42, 17.16)). CONCLUSION Misdiagnosis is a frequent problem in MS care. Non-specific brain lesions were the most significant predictor of misdiagnosis. Interventions aimed to reduce over-reliance on imaging findings and misapplication of the McDonald criteria may prevent MS misdiagnosis.
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Affiliation(s)
- Yujie Wang
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicole Bou Rjeily
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacqueline Koshorek
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Risto Grkovski
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manek Aulakh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Solomon AJ, Marrie RA, Viswanathan S, Correale J, Magyari M, Robertson NP, Saylor DR, Kaye W, Rechtman L, Bae E, Shinohara R, King R, Laurson-Doube J, Helme A. Global Barriers to the Diagnosis of Multiple Sclerosis: Data From the Multiple Sclerosis International Federation Atlas of MS, Third Edition. Neurology 2023; 101:e624-e635. [PMID: 37321866 PMCID: PMC10424832 DOI: 10.1212/wnl.0000000000207481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/18/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Recent data suggest increasing global prevalence of multiple sclerosis (MS). Early diagnosis of MS reduces the burden of disability-adjusted life years and associated health care costs. Yet diagnostic delays persist in MS care and even within national health care systems with robust resources, comprehensive registries, and MS subspecialist referral networks. The global prevalence and characteristics of barriers to expedited MS diagnosis, particularly in resource-restricted regions, have not been extensively studied. Recent revisions to MS diagnostic criteria demonstrate potential to facilitate earlier diagnosis, but global implementation remains largely unknown. METHODS The Multiple Sclerosis International Federation third edition of the Atlas of MS was a survey that assessed the current global state of diagnosis including adoption of MS diagnostic criteria; barriers to diagnosis with respect to the patient, health care provider, and health system; and existence of national guidelines or national standards for speed of MS diagnosis. RESULTS Coordinators from 107 countries (representing approximately 82% of the world population), participated. Eighty-three percent reported at least 1 "major barrier" to early MS diagnosis. The most frequently reported barriers included the following: "lack of awareness of MS symptoms among general public" (68%), "lack of awareness of MS symptoms among health care professionals" (59%), and "lack of availability of health care professionals with knowledge to diagnose MS" (44%). One-third reported lack of "specialist medical equipment or diagnostic tests." Thirty-four percent reported the use of only 2017 McDonald criteria (McD-C) for diagnosis, and 79% reported 2017 McD-C as the "most commonly used criteria." Sixty-six percent reported at least 1 barrier to the adoption of 2017 McD-C, including "neurologists lack awareness or training" by 45%. There was no significant association between national guidelines pertaining to MS diagnosis or practice standards addressing the speed of diagnosis and presence of barriers to early MS diagnosis and implementation of 2017 McD-C. DISCUSSION This study finds pervasive consistent global barriers to early diagnosis of MS. While these barriers reflected a lack of resources in many countries, data also suggest that interventions designed to develop and implement accessible education and training can provide cost-effective opportunities to improve access to early MS diagnosis.
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Affiliation(s)
- Andrew J Solomon
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom.
| | - Ruth Ann Marrie
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Shanthi Viswanathan
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Jorge Correale
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Melinda Magyari
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Neil P Robertson
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Deanna R Saylor
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Wendy Kaye
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Lindsay Rechtman
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Eunchan Bae
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Russell Shinohara
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Rachel King
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Joanna Laurson-Doube
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
| | - Anne Helme
- From the Department of Neurological Sciences (A.J.S.), Larner College of Medicine at the University of Vermont, Burlington; Departments of Internal Medicine and Community Health Science (R.A.M.), Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Neurology (S.V.), Kuala Lumpur Hospital, Malaysia; Departamento de Neurologia (J.C.), Fleni, Buenos Aires; Institute of Biological Chemistry and Physical Chemistry (IQUIFIB) (J.C.), National Council for Scientific and Technical Research/University of Buenos Aires, Argentina; Department of Neurology (M.M.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Psychological Medicine and Clinical Neuroscience (N.P.R.), Department of Neurology, Cardiff University, University Hospital of Wales, United Kingdom; Department of Neurology (D.R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (D.R.S.), University Teaching Hospital, Lusaka, Zambia; McKing Consulting Corporation (W.K., L.R.), Atlanta, GA; Department of Biostatistics, Epidemiology, and Informatics (E.B., R.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Multiple Sclerosis International Federation (R.K., J.L.-D., A.H.), London, United Kingdom
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Carnero Contentti E, López PA, Criniti J, Alonso R, Silva B, Luetic G, Correa-Díaz EP, Galleguillos L, Navas C, Soto de Castillo I, Hamuy FDDB, Gracia F, Tkachuk V, Weinshenker BG, Rojas JI. Frequency of NMOSD misdiagnosis in a cohort from Latin America: Impact and evaluation of different contributors. Mult Scler 2023; 29:277-286. [PMID: 36453614 DOI: 10.1177/13524585221136259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) misdiagnosis (i.e. the incorrect diagnosis of patients who truly have NMOSD) remains an issue in clinical practice. We determined the frequency and factors associated with NMOSD misdiagnosis in patients evaluated in a cohort from Latin America. METHODS We retrospectively reviewed the medical records of patients with NMOSD, according to the 2015 diagnostic criteria, from referral clinics in six Latin American countries (Argentina, Chile, Paraguay, Colombia, Ecuador, and Venezuela). Diagnoses prior to NMOSD and ultimate diagnoses, demographic, clinical and paraclinical data, and treatment schemes were evaluated. RESULTS A total of 469 patients presented with an established diagnosis of NMOSD (73.2% seropositive) and after evaluation, we determined that 56 (12%) patients had been initially misdiagnosed with a disease other than NMOSD. The most frequent alternative diagnoses were multiple sclerosis (MS; 66.1%), clinically isolated syndrome (17.9%), and cerebrovascular disease (3.6%). NMOSD misdiagnosis was determined by MS/NMOSD specialists in 33.9% of cases. An atypical MS syndrome was found in 86% of misdiagnosed patients, 50% had NMOSD red flags in brain and/or spinal magnetic resonance imaging (MRI), and 71.5% were prescribed disease-modifying drugs. CONCLUSIONS NMOSD misdiagnosis is relatively frequent in Latin America (12%). Misapplication and misinterpretation of clinical and neuroradiological findings are relevant factors associated with misdiagnosis.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina/Sección Enfermedades Desmielinizantes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Lorna Galleguillos
- Clínica Alemana de Santiago, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile
| | - Carlos Navas
- Clínica Enfermedad Desmielinizante, Clinica Universitaria Colombia, Bogotá, Colombia
| | | | | | - Fernando Gracia
- Hospital Santo Tomas, Universidad Interamericana de Panamá, Panama City, Panamá
| | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín," Buenos Aires, Argentina
| | | | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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8
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Aybek S, Chan A. The borderland of multiple sclerosis and functional neurological disorder: A call for clinical research and vigilance. Eur J Neurol 2023; 30:3-8. [PMID: 36135345 DOI: 10.1111/ene.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Functional neurological disorders (FNDs) have attracted much attention from the neurological medical community over the last decades as new developments in neurosciences have reduced stigma around these by showing brain network dysfunctions. An overlap with other neurological conditions such as multiple sclerosis (MS) is well known by clinicians but there is a lack of clinical and fundamental research in this field to better define diagnosis and therapeutic decisions, as well as a lack of deep understanding of the underlying pathophysiology. AIM We aimed to provide a critical commentary on the state of knowledge about the borderland between FNDs and MS. METHODS We based our commentary on a joint point of view between an FND specialist and an MS expert. RESULTS A brief review of the previous literature and relevant new studies covering the overlap between FNDs and MS is presented, along with suggestions for future research directions. CONCLUSION There are clear diagnostic criteria for both FNDs and MS and a strict application of these will help better diagnosis and prevent unnecessary treatment escalation in MS or absence of referral to multimodal therapy in FND. Better teaching of younger neurologists is needed as well as prospective research focusing on pathophysiology.
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Affiliation(s)
- Selma Aybek
- Psychosomatic Medicine Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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9
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Solomon AJ, Arrambide G, Brownlee W, Cross AH, Gaitan MI, Lublin FD, Makhani N, Mowry EM, Reich DS, Rovira À, Weinshenker BG, Cohen JA. Confirming a Historical Diagnosis of Multiple Sclerosis: Challenges and Recommendations. Neurol Clin Pract 2022; 12:263-269. [PMID: 35747540 PMCID: PMC9208427 DOI: 10.1212/cpj.0000000000001149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022]
Abstract
Patients with a historical diagnosis of multiple sclerosis (MS)-a patient presenting with a diagnosis of MS made previously and by a different clinician-present specific diagnostic and therapeutic challenges in clinical practice. Application of the McDonald criteria is most straightforward when applied contemporaneously with a syndrome typical of an MS attack or relapse; however, retrospective application of the criteria in some patients with a historical diagnosis of MS can be problematic. Limited patient recollection of symptoms and evolution of neurologic examination and MRI findings complicate confirmation of an earlier MS diagnosis and assessment of subsequent disease activity or clinical progression. Adequate records for review of prior clinical examinations, laboratory results, and/or MRI scans obtained at the time of diagnosis or during ensuing care may be inadequate or unavailable. This article provides recommendations for a clinical approach to the evaluation of patients with a historical diagnosis of MS to aid diagnostic confirmation, avoid misdiagnosis, and inform therapeutic decision making.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Georgina Arrambide
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Wallace Brownlee
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Anne H Cross
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - María I Gaitan
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Fred D Lublin
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Naila Makhani
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Ellen M Mowry
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel S Reich
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Àlex Rovira
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Brian G Weinshenker
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Jeffrey A Cohen
- Department of Neurological Sciences (AJS), Larner College of Medicine at the University of Vermont, University Health Center - Arnold 2, Burlington, VT; Servei de Neurologia-Neuroimmunologia (GA), Centre d'Esclerosi Múltiple de Catalunya, (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; National Hospital for Neurology and Neurosurgery (WB), London, United Kingdom; Department of Neurology (AHC), Washington University School of Medicine, St. Louis, MO; Department of Neurology (MIG), Neuroimmunology Section, FLENI, Buenos Aires City, Argentina; The Corinne Goldsmith Dickinson Center for Multiple Sclerosis (FDL), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Pediatrics and Neurology (NM), Yale School of Medicine, New Haven, CT; Multiple Sclerosis Precision Medicine Center of Excellence (EMM), Johns Hopkins University, Baltimore, MD; Translational Neuroradiology Section (DSR), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Section of Neuroradiology (ÀR), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (BGW), Mayo Clinic, Rochester, MN; and Mellen Center for MS Treatment and Research (JAC), Neurological Institute, Cleveland Clinic, Cleveland, OH
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10
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Lashgari G, Solomon AJ, Kaisey M. Teaching Cases in Differential Diagnosis: Misdiagnosis of MS Perpetuated for 14 Years. Mult Scler Relat Disord 2022; 64:103950. [DOI: 10.1016/j.msard.2022.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
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11
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Kokas Z, Sandi D, Fricska-Nagy Z, Füvesi J, Biernacki T, Köves Á, Fazekas F, Birkás AJ, Katona G, Kovács K, Milanovich D, Dobos E, Kapás I, Jakab G, Csépány T, Bense E, Mátyás K, Rum G, Szolnoki Z, Deme I, Jobbágy Z, Kriston D, Gerócs Z, Diószeghy P, Bors L, Varga A, Kerényi L, Molnár G, Kristóf P, Nagy ZÁ, Sátori M, Imre P, Péntek S, Klivényi P, Kincses ZT, Vécsei L, Bencsik K. Do Hungarian multiple sclerosis care units fulfil international criteria? PLoS One 2022; 17:e0264328. [PMID: 35239686 PMCID: PMC8893632 DOI: 10.1371/journal.pone.0264328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
A patients Because of the past 3 decades’ extensive research, several disease modifying therapies became available, thus a paradigm change is multiple sclerosis care was necessary. In 2018 a therapeutic guideline was created recommending that treatment of persons with multiple sclerosis should take place in specified care units where the entire spectrum of disease modifying therapies is available, patient monitoring is ensured, and therapy side effects are detected and treated promptly. In 2019 multiple sclerosis care unit criteria were developed, emphasizing personnel and instrumental requirements to provide most professional care. However, no survey was conducted assessing the real-world adaptation of these criteria. Objective To assess whether Hungarian care units fulfil international criteria. Methods A self-report questionnaire was assembled based on international guidelines and sent to Hungarian care units focusing on 3 main aspects: personnel and instrumental background, disease-modifying therapy use, number of people living with multiple sclerosis receiving care in care units. Data on number of persons with multiple sclerosis were compared to Hungarian prevalence estimates. Descriptive statistics were used to analyse data. Results Out of 27 respondent care units, 3 fulfilled minimum requirements and 7 fulfilled minimum and recommended requirements. The least prevalent neighbouring specialties were spasticity and pain specialist, and neuro-ophthalmologist and oto-neurologist. Only 15 centres used all available disease modifying therapies. A total number of 7213 people with multiple sclerosis received care in 27 respondent centres. Compared to prevalence estimates, 2500 persons with multiple sclerosis did not receive multiple sclerosis specific care in Hungary. Conclusion Less than half of Hungarian care units provided sufficient care for people living with multiple sclerosis. Care units employing fewer neighbouring specialties, might have difficulties diagnosing and providing appropriate care for persons with multiple sclerosis, especially for people with progressive disease course, contributing to the reported low number of persons living with multiple sclerosis.
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Affiliation(s)
- Zsófia Kokas
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Tamás Biernacki
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Ágnes Köves
- Department of Neurology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Ferenc Fazekas
- Department of Neurology, Gyula Nyírő Hospital and National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Adrienne Jóri Birkás
- Department of Neurology, National Institute of Clinical Nerosciences, Budapest, Hungary
| | - Gabriella Katona
- Department of Neurology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | | | | | - Enikő Dobos
- Department of Neurology, Saint Imre Hospital and University Teaching Hospital, Budapest, Hungary
| | - István Kapás
- Department of Neurology, Saint János Hospital, Budapest, Hungary
| | - Gábor Jakab
- Department of Neurology, Uzsoki Hospital, Budapest, Hungary
| | - Tünde Csépány
- Division of Neurology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Erzsébet Bense
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Klotild Mátyás
- Department of Neurology, Ferenc Markhot Teaching Hospital, Eger, Hungary
| | - Gábor Rum
- Department of Neurology, Aladár Petz University Teaching Hospital, Győr, Hungary
| | - Zoltán Szolnoki
- Department of Neurology, Kálmán Pándy County Hospital, Gyula, Hungary
| | - István Deme
- Department of Neuology, Mór Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Zita Jobbágy
- Department of Neurology, Kecskemét County Hospital, Kecskemét, Hungary
| | - Dávid Kriston
- Department of Neurology, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Zsuzsanna Gerócs
- Department of Neurology, Dorottya Kanizsai Hospital, Nagykanizsa, Hungary
| | - Péter Diószeghy
- Department of Neurology, Aladár Jósa Teaching Hospital, Nyíregyháza, Hungary
| | - László Bors
- Department of Neurology, University of Pécs Clinical Center Pécs, Pécs, Hungary
| | - Adrián Varga
- Department of Neurology, Saint Lázár County Hospital, Salgótarján, Hungary
| | - Levente Kerényi
- Department of Neurology, Fejér County Saint György University Teaching Hospital, Székesfehérvár, Hungary
| | - Gabriella Molnár
- Department of Neurology, János Balassa Hospital, Szekszárd, Hungary
| | - Piroska Kristóf
- Department of Neurology, Jász-Nagykun-Szolnok County Géza Hetényi Hospital, Szolnok, Hungary
| | - Zsuzsanna Ágnes Nagy
- Department of Neurology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Mária Sátori
- Department of Neurology, Saint Borbála Hospital, Tatabánya, Hungary
| | - Piroska Imre
- Department of Neurology, Ferenc Csolnoky Hospital, Veszprém, Hungary
| | - Szilvia Péntek
- Department of Neurology, Zala County Saint Rafael Hospital, Zalaegerszeg, Hungary
| | - Péter Klivényi
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsigmond Tamás Kincses
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
- Faculty of General Medicine, Department of Radiology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Krisztina Bencsik
- Faculty of General Medicine, Department of Neurology, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
- * E-mail:
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