How to Correct a Misdiagnosis of MS

As the study’s authors observed, evidence of therapeutic benefit from early initiation of DMT in patients with MS generates a sense of urgency to diagnose the disease early and begin therapy, Dr. Moses said. However, misdiagnosis in many cases may have resulted from—in place of prudent clinical and laboratory monitoring—an overreliance on MRI findings in patients with syndromes for which established MS diagnostic imaging criteria have not been validated. “Ultimately, MS remains a clinical diagnosis,” said Dr. Moses. “You use an MRI as an adjunct to help you confirm a diagnosis.”

Misdiagnosis of MS can cause serious harm. For example, conditions such as neuromyelitis optica and cervical spondylosis can lead to irreversible disability if unrecognized and inappropriately treated. Use of DMT in patients without MS exposes them to unnecessary health risks and financial costs. Dr. Moses cited the case of a 45-year-old woman who probably did not have MS but whose treatment with interferon beta-1a likely resulted in her going on dialysis. “These drugs are not benign,” he said. “[Such an outcome] is a very rare thing, but keep in mind that if a patient does not have MS, he or she should not be on MS therapy.”

Invested in the Diagnosis

As discussed by Boissy and Ford, neurologists may be inclined to use a medically inaccurate label, such as “a touch of MS,” “mild MS,” “benign MS,” or “MS by history,” when talking with patients who have received a misdiagnosis of MS, Dr. Moses said. Patients who have attributed psychogenic symptoms to misdiagnosed MS often resist a psychogenic explanation. In addition, they may be invested physically, emotionally, and financially in the diagnosis of MS—making treatment challenging for clinicians, Dr. Moses said.

Therapeutic mislabeling raises ethical issues, however. Mislabeling may expose patients to risky therapies, lead to an inappropriate use of resources, compromise the credibility of the clinician, and cause psychologic harm to the patient.

Neurologists would do better to consider scheduling multiple visits to explore psychogenic factors, as well as the patient’s fears and emotions, with the aim of developing a rapport and encouraging appropriate evaluations, Dr. Moses said. “If physicians endorse an inaccurate diagnosis, this undoubtedly conflicts with their professional obligations for truth telling, avoiding harming patients, … acting in the patient’s best interest, and stewardship of medical resources,” he said.

—Fred Balzac

Suggested Reading

Boissy AR, Ford PJ. A touch of MS: therapeutic mislabeling. Neurology. 2012;78(24):1981-1985.

Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: a multicenter study. Neurology. 2016;87(13):1393-1399.

Solomon AJ, Klein EP, Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012;78(24):1986-1991.