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Pseudo-multiple sclerosis: a clinico-epidemiological study
G J Hankey1, E G Stewart-Wynne
1Department of Neurology, Royal Perth Hospital, WA.
Abstract:
Despite the advance represented by nuclear magnetic resonance imaging, the diagnosis of multiple sclerosis (MS) remains clinical. It has been our impression that a diagnosis of MS reduces further critical neurological thought and assumes an air of certainty after a number of visits in the absence of any new evidence for the diagnosis. One of us (E.G.S-W.), as part of a nationwide epidemiological study, reviewed 387 patients in Western Australia who had been diagnosed as having MS. Three diagnostic sub-groups were identified: group A--318 patients considered to have MS, group B--32 patients with an alternative chronic neurological disorder, and group C--35 patients not considered to have a neurological illness. Patients in group C were predominantly females (89%) and nurses (34%) with an earlier age of onset of symptoms (mean 28 years, range 12-46 years). Frequent clinical features included monocular diplopia, tunnel vision, 'give-way' weakness and hemisensory loss of all modalities of sensation. The major clinical features of patients in group B, which were atypical for MS, included onset of non-remitting, progressive disease before age 35 years, localised disease, and normal optic nerves and eye movements. The results of this study serve to promote critical analysis of the accuracy of diagnosis of MS in individual cases.
Insights
Accurate multiple sclerosis (MS) diagnosis is crucial. This study reviewed 387 MS diagnoses, finding many patients had alternative conditions or no neurological illness, highlighting diagnostic challenges.
Area of Science:
- Neurology
- Epidemiology
Background:
- Multiple sclerosis (MS) diagnosis relies heavily on clinical assessment, even with advancements like MRI.
- A perceived diagnostic certainty in MS may hinder critical re-evaluation.
- Epidemiological studies are vital for assessing diagnostic accuracy in neurological disorders.
Purpose of the Study:
- To critically analyze the accuracy of multiple sclerosis diagnoses.
- To identify potential misdiagnoses and their characteristics within a large patient cohort.
- To promote rigorous diagnostic evaluation in suspected MS cases.
Main Methods:
- A review of 387 patients diagnosed with multiple sclerosis (MS) in Western Australia.
- Classification of patients into three diagnostic subgroups: confirmed MS, alternative chronic neurological disorder, and non-neurological illness.
- Analysis of clinical features and demographics for each subgroup.
Main Results:
- Out of 387 reviewed diagnoses, only 318 patients (Group A) were considered to have MS.
- 32 patients (Group B) were diagnosed with alternative chronic neurological disorders.
- 35 patients (Group C) were found not to have a neurological illness, predominantly females with early symptom onset and specific symptoms like diplopia and sensory loss.
Conclusions:
- The study underscores significant inaccuracies in multiple sclerosis diagnoses.
- Patients diagnosed with MS may suffer from other neurological conditions or unrelated illnesses.
- A critical review of MS diagnostic criteria and application is essential to improve patient care.