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Updated: Jul 4, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Long-term follow-up of suspected though unconfirmed MS
J M Nielsen1, B M J Uitdehaag, C H Polman
1Department of Neurology, VU University Medical Center, MS Center, Amsterdam, The Netherlands. jm.nielsen@vumc.nl
Objective:
There is no gold standard diagnostic test for MS, and evaluation of present diagnostic criteria has almost exclusively been done in populations of which the vast majority is prone to develop MS. Patients referred for a potential MS diagnosis in whom ultimately another or no diagnosis is made are seldomly reported in a systematic way. We report, after 7 years, on the diagnoses made in a cohort of patients with suspected though unconfirmed MS.
Methods:
We retrieved information on the current diagnosis of all patients who had visited our center between 1998 and 2001 for a second opinion concerning a possible MS diagnosis and in whom no diagnosis had been made at that time.
Results:
Seventy-five patients (86%) could be retrieved and cooperated. In seven patients, a diagnosis of MS, in eight patients another neurological diagnosis had been made. In the remaining 60 patients, still no neurological diagnosis had been made.
Conclusions:
In potential MS patients seen in a tertiary referral center, the likelihood that a patient who is not diagnosed with MS will in the future develop a neurological disease is small. This study suggests that, in addition to playing a role in diagnosing MS, MRI can be helpful to exclude MS in clinically doubtful cases.
Insights
In patients suspected of multiple sclerosis (MS), a definitive diagnosis is rare. This study found that most patients referred for MS evaluation do not develop neurological diseases, suggesting MRI can help exclude MS.
Area of Science:
- Neurology
- Diagnostic Imaging
Background:
- Multiple sclerosis (MS) lacks a definitive diagnostic test.
- Diagnostic criteria evaluations often exclude patients without confirmed MS.
- Systematic reporting on patients with suspected but unconfirmed MS is limited.
Purpose of the Study:
- To report the long-term diagnoses in a cohort of patients with suspected but unconfirmed multiple sclerosis (MS).
- To evaluate the diagnostic yield in a tertiary referral center for patients with suspected MS.
- To assess the utility of Magnetic Resonance Imaging (MRI) in excluding MS.
Main Methods:
- Retrospective cohort study of patients seeking a second opinion for possible MS between 1998-2001.
- Information on final diagnoses was retrieved after a 7-year follow-up period.
- Included patients had no definitive diagnosis at the time of their initial visit.
Main Results:
- 75 patients (86%) were included in the 7-year follow-up.
- Only 7 patients were ultimately diagnosed with MS.
- 8 patients received another neurological diagnosis, while 60 remained undiagnosed.
Conclusions:
- Patients referred for suspected MS at a tertiary center rarely develop neurological diseases if not diagnosed initially.
- MRI may be valuable in ruling out MS in clinically ambiguous cases.
- This highlights the importance of systematic follow-up for undiagnosed neurological conditions.
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