title: The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study.
abstract: 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.
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN. andrew.solomon@uvm.edu.
authors: Andrew J
authors: AJ
authors: Solomon
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Dennis N
authors: DN
authors: Bourdette
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Anne H
authors: AH
authors: Cross
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Angela
authors: A
authors: Applebee
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Philip M
authors: PM
authors: Skidd
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Diantha B
authors: DB
authors: Howard
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Rebecca I
authors: RI
authors: Spain
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Michelle H
authors: MH
authors: Cameron
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Edward
authors: E
authors: Kim
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Michele K
authors: MK
authors: Mass
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Vijayshree
authors: V
authors: Yadav
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Ruth H
authors: RH
authors: Whitham
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Erin E
authors: EE
authors: Longbrake
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Robert T
authors: RT
authors: Naismith
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Gregory F
authors: GF
authors: Wu
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Becky J
authors: BJ
authors: Parks
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Dean M
authors: DM
authors: Wingerchuk
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Brian L
authors: BL
authors: Rabin
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Michel
authors: M
authors: Toledano
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: W Oliver
authors: WO
authors: Tobin
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Orhun H
authors: OH
authors: Kantarci
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Jonathan L
authors: JL
authors: Carter
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: B Mark
authors: BM
authors: Keegan
authors: From the Departments of Neurological Sciences (A.J.S., A.A.) and Ophthalmology (P.M.S.), and Center for Clinical and Translational Science (D.B.H.), University of Vermont, Burlington; Department of Neurology (D.N.B., R.I.S., M.H.C., E.K., M.K.M., V.Y., R.H.W.), Oregon Health & Science University, Portland; Department of Neurology (A.H.C., E.E.L., R.T.N., G.F.W., B.J.P.), Washington University, St. Louis, MO; Department of Neurology (D.M.W., B.L.R., J.L.C.), Mayo Clinic, Scottsdale, AZ; and Department of Neurology (M.T., W.O.T., O.H.K., B.M.K., B.G.W.), Mayo Clinic, Rochester, MN.
authors: Brian G
authors: BG
authors: Weinshenker
mesh_terms: D000046:Academic Medical Centers; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002986:Clinical Trials as Topic; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D056747:Immunomodulation; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000628:therapy; D014481:United States
chemical_list: D015415:Biomarkers