6533b7d7fe1ef96bd1269020
RESEARCH PRODUCT
“Better explanations” in multiple sclerosis diagnostic workup
Massimiliano Calabrese 1Claudio Gasperini 2Carla Tortorella 2Gianmarco Schiavi 2Giovanni Frisullo 2Paolo RagoneseRoberta Fantozzi 2Luca Prosperini 2Pietro Annovazzi 2Cinzia Cordioli 2Massimiliano Di Filippo 2Diana Ferraro 2Alberto Gajofatto 2Simona Malucchi 2Salvatore Lo Fermo 2Giovanna De Luca 2Maria L Stromillo 2Eleonora Cocco 2Antonio Gallo 2Damiano Paolicelli 2Roberta Lanzillo 2Valentina Tomassini 2Ilaria Pesci 2Maria E Rodegher 2Claudio Solaro 2Rirems Group (Rising Italian Researchers In Multiple Sclerosis)subject
Male404241Longitudinal StudieDisease0302 clinical medicineMultiple SclerosiDiagnosisMedicine030212 general & internal medicineProspective StudiesLongitudinal StudiesProspective cohort studymedicine.diagnostic_testMagnetic Resonance Imagingclinical practiceatypical MRI lesionsMS mimicsDisease ProgressionFemaleSettore MED/26 - NeurologiaRadiologyHumanAdultmultiple sclerosis; diagnostic criteria; atypical MRI lesions; MS mimics; clinical practicemedicine.medical_specialtyMultiple Sclerosis2omarkers / metabolism Diagnosis Differential Female Follow-Up Studies Humans Longitudinal Studies Magnetic Resonance Imaging Male Multiple Sclerosis / diagnosis* Prospective StudiesArticleFollow-Up StudieDiagnosis Differential03 medical and health sciencesHumansNeuromyelitis opticabusiness.industryMultiple sclerosisAdult; Biomarkers; Diagnosis Differential; Female; Follow-Up Studies; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Multiple Sclerosis; Prospective StudiesMagnetic resonance imagingOdds ratioBiomarkermedicine.disease101MigraineDifferentialdiagnostic criteriaNeurology (clinical)Differential diagnosisbusiness030217 neurology & neurosurgeryBiomarkersFollow-Up Studiesdescription
BackgroundThe exclusion of other diseases that can mimic multiple sclerosis (MS) is the cornerstone of current diagnostic criteria. However, data on the frequency of MS mimics in real life are incomplete.MethodsA total of 695 patients presenting with symptoms suggestive of MS in any of the 22 RIREMS centers underwent a detailed diagnostic workup, including a brain and spinal cord MRI scan, CSF and blood examinations, and a 3-year clinical and radiologic follow-up.FindingsA total of 667 patients completed the study. Alternative diagnoses were formulated in 163 (24.4%) cases, the most frequent being nonspecific neurologic symptoms in association with atypical MRI lesions of suspected vascular origin (40 patients), migraine with atypical lesions (24 patients), and neuromyelitis optica (14 patients). MS was diagnosed in 401 (60.1%) patients according to the 2017 diagnostic criteria. The multivariate analysis revealed that the absence of CSF oligoclonal immunoglobulin G bands (IgG-OB) (odds ratio [OR] 18.113), the presence of atypical MRI lesions (OR 10.977), the absence of dissemination in space (DIS) of the lesions (OR 5.164), and normal visual evoked potentials (OR 3.550) were all independent predictors of an alternative diagnosis.InterpretationThis observational, unsponsored, real-life study, based on clinical practice, showed that diseases that mimicked MS were many, but more than 45% were represented by nonspecific neurologic symptoms with atypical MRI lesions of suspected vascular origin, migraine, and neuromyelitis optica. The absence of IgG-OB and DIS, the presence of atypical MRI lesions, and normal visual evoked potentials should be considered suggestive of an alternative disease and red flags for the misdiagnosis of MS.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-01-01 | Neurology |