Functional symptoms in clinically definite MS--pseudo-relapse syndrome

Area of Science:

• Neurology
• Clinical Medicine

Background:

• Multiple Sclerosis (MS) diagnosis relies on formalized criteria and Magnetic Resonance Imaging (MRI).
• Assessing acute neurological episodes can be difficult, particularly outside standard clinical settings or working hours.
• Emergency department physicians may lack specialized neurological training and face time constraints.

Observation:

• Acute episodes in MS patients may not always correlate with specific MRI lesions.
• Functional symptoms can be misidentified as true MS relapses due to diagnostic challenges.
• Three clinical vignettes illustrate potential scenarios of pseudo-relapse in MS.

Findings:

• Misclassification of functional symptoms as MS relapses carries significant risks.
• Functional symptoms can be multifactorial and contribute to disease burden.
• Accurate diagnosis is crucial to avoid unnecessary harm and manage patient care effectively.

Implications:

• A multidisciplinary approach is recommended for evaluating episodes of clinical deterioration in MS patients.
• Improved diagnostic strategies are needed to differentiate true relapses from functional symptoms.
• Recognizing pseudo-relapse is essential for appropriate patient management and minimizing iatrogenic harm.