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"Better explanations" in multiple sclerosis diagnostic workup: A 3-year longitudinal study.

Massimiliano Calabrese1, Claudio Gasperini2, Carla Tortorella2

  • 1From the Departments of Neuroscience, Biomedicine and Movement (M.C., A. Gajofatto) and Neurological and Movement Sciences (G.S.), University of Verona; Department of Neurosciences (C.G., C.T.), Azienda Ospedaliera San Camillo Forlanini, Roma; Department of Basic Medical Sciences, Neurosciences and Sense Organs (C.T., D.P.), University of Bari; Policlinico Gemelli (G.F.), Rome; Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC) (P.R.), Università di Palermo; Istituto Neurologico Mediterraneo (R.F.), Pozzilli; Department of Neurology and Psychiatry (L.P.), Sapienza University of Rome; Multiple Sclerosis Center (P.A.), ASST Valle Olona, PO di Gallarate; Multiple Sclerosis Center (C.C.), Ospedale di Montichiari, Spedali Civili di Brescia; Clinica Neurologica (M.D.), Dipartimento di Medicina, Università di Perugia; Department of Biomedical, Metabolic and Neurosciences (D.F.), University of Modena and Reggio Emilia, Modena; Neurologia 2-CRESM (S.M.), AOU San Luigi Gonzaga, Orbassano; Multiple Sclerosis Centre (S.L.), A.O.U. Policlinico-Vittorio Emanuele, Catania; Neurology Clinic (G.D.), Multiple Sclerosis Center, SS. Annunziata Hospital, Chieti; Department of Medicine, Surgery and Neuroscience (M.L.S.), University of Siena; Department of Medical Science and Public Health (E.C.), University of Cagliari; Department of Medical, Surgical, Neurological, Metabolic and Aging Science (A. Gallo), University of Campania; Department of Neuroscience, Reproductive Sciences (R.L.), University Federico II, Naples, Italy; Institute of Psychological Medicine and Clinical Neurosciences (V.T.), Cardiff University School of Medicine, UK; Ospedale di Vaio (I.P.), Centro SM, Fidenza, Parma; Ospedale San Raffaele (M.E.R.), Milan; and Department of Rehabilitation (C.S.), Mons L Novarese Hospital, Moncrivello, Italy. massimiliano.calabrese@univr.it.

Neurology
|May 3, 2019
PubMed

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Summary

Many diseases mimic multiple sclerosis (MS), with nonspecific neurologic symptoms and vascular MRI lesions being common. Key indicators for alternative diagnoses include absence of cerebrospinal fluid oligoclonal immunoglobulin G bands (IgG-OB) and dissemination in space (DIS).

Area of Science:

  • Neurology
  • Diagnostic Imaging
  • Clinical Immunology

Background:

  • Accurate diagnosis of multiple sclerosis (MS) relies on excluding conditions with similar symptoms.
  • Real-world data on the frequency and types of MS mimics are limited, impacting diagnostic confidence.

Purpose of the Study:

  • To investigate the frequency and characteristics of diseases mimicking MS in a large, real-world cohort.
  • To identify clinical and imaging predictors that suggest an alternative diagnosis over MS.

Main Methods:

  • A prospective observational study included 695 patients with suspected MS across 22 centers.
  • Diagnostic workup involved MRI, CSF, blood tests, and a 3-year follow-up.
  • Multivariate analysis identified predictors of alternative diagnoses.

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Main Results:

  • Of 667 patients completing the study, 24.4% received an alternative diagnosis.
  • Common mimics included nonspecific neurologic symptoms with vascular MRI lesions (40 patients), migraine (24), and neuromyelitis optica (14).
  • Absence of CSF oligoclonal immunoglobulin G bands (IgG-OB) and dissemination in space (DIS), atypical MRI lesions, and normal visual evoked potentials were significant predictors of alternative diagnoses.

Conclusions:

  • Diseases mimicking MS are frequent, with nonspecific neurologic symptoms and vascular MRI lesions being the most common.
  • Specific findings like absent IgG-OB, DIS, atypical lesions, and normal VEPs are crucial red flags for misdiagnosis of MS.