If you’ve just been diagnosed with multiple sclerosis (MS), your first step may require getting a second opinion.
It can be said that this is a file message A study published in May 2019 in the journal Multiple sclerosis and related disorders. When reviewing 241 people diagnosed with multiple sclerosis who were referred to either Cedars-Sinai Medical Center or UCLA Health MS Clinic, both in Los Angeles, over the course of a year, study authors found that nearly 18 percent were misdiagnosed.
The lead author noted, “Diagnosing MS is challenging.” Marwa Qaisi, MD, a neurologist at Cedars-Sinai, in a statement issued by the hospital. “Both symptoms and MRI test results can look like other conditions, such as stroke, migraine, and vitamin B12 deficiency. [As a physician]You have to rule out any other diagnoses, and that’s not a perfect science.”
Perhaps most disturbingly, Dr. Casey and her colleagues found that many MS patients referred to hospitals (likely by other Southern California area physicians) had not even met Acceptable Diagnostic Criteriaas recently identified in 2017.
Related: Advances in MS Diagnosis
Exorbitant costs of treatment for a disease that you do not have
However, in the cases included in the analysis, the majority of patients (72 percent) spent an average of four years on MS treatment before receiving a correct diagnosis. This is important because of the risks associated with many MS medications.
According to the authors, the most common correct diagnoses among those who are misdiagnosed are migraine, radiologically isolated syndrome (presence of MS lesions but not symptoms), spondylopathy (disorders of the vertebrae), and nerve damage (neuropathy).
“I’ve seen patients with side effects from medications they were taking for a disease they didn’t have,” Casey says. “In the meantime, they haven’t been treated for what they got. The cost to the patient is huge – medically, psychologically and financially. The first step, which we’ve done here, is to identify the problem, so we are now working on potential solutions.”
There is no single test to diagnose MS
He adds, “Part of the reason there is a relatively high degree of misdiagnosis in MS is that there is still no single test, such as a blood test, for the condition.” Jeffrey Cohen, MDMD, director of experimental treatments at the Mellin Multiple Sclerosis Center at Cleveland Clinic in Ohio and one of the authors of the most recent diagnostic criteria for the condition, Published in February 2018 in the magazine Neuroscience Lancet. “Basically, how we diagnose MS is that we build a case for it based on people’s symptoms and MRI findings, and rule out other possibilities.”
Unfortunately, according to Dr. Cohen, this process is further complicated by the fact that many of the hallmark symptoms of MS — such as fatigue, for example — are also common in other conditions.
Can ultra-high-power MRI machines reduce the number of misdiagnoses?
One possible treatment for misdiagnosing MS may be to increase the use of ultra-high-strength MRI with the 7-Tesla(T) scanner – a very powerful device that has more than twice the strength of the magnetic field. Common 3T scanners (which in turn are more powerful than the 1.5T scanner).
in Study published April 9, 2019 in the journal rays that followed 20 people with relapsing-remitting MS and 13 people with secondary progressive MS, along with 10 healthy age-matched controls, a so-called 7T MRI revealed that 25 people per year, or 80 percent, develop new cortical lesions. , which has been more frequently detected with new technology compared to previous studies using 3T systems.
The authors found that the total volume of cortical lesions in people with MS was a predictor of neurological impairment at both the baseline and follow-up assessment. Among those observed in the study, 7T brain scans showed that cortical lesions tended to accumulate in grooves on the surface of the brain called sulci.
“Because 7T MRI is more sensitive to cortical lesions than lower-field MRI, we can detect many of these lesions that we have not been able to see before, and determine whether they are closely related to neurological impairment and disease progression,” explained the study’s first author. Katrina Mineiro, MD, PhD, of the Athenola A. Martinus Center for Biomedical Imaging at Massachusetts General Hospital in Boston, in press release about the results.
“This could have a very powerful impact on how patients with MS are monitored. We can also use this tool to see how potential treatments might affect the development and progression of cortical lesions,” says Dr. Mineiro.
3T MRI platforms are capable of obtaining accurate diagnoses of MS
7T technology is still not widely available, according to Cohen, in part due to the costs associated with installing it. In addition, aspects of the platform have not yet received approval from the US Food and Drug Administration (FDA).
However, Cohen cites Research published in October 2016 in the journal MRI in medicinewhich indicated that 3T MRI platforms are able to obtain the detailed images needed for an accurate diagnosis of MS.
He points out that patients can play an important role in ensuring an accurate diagnosis by sharing detailed information about their symptoms and understanding that proper diagnosis and treatment can take time.
“Diagnosing MS requires putting all the available information together,” Cohen says. And sometimes, people may have to live with some uncertainty. As clinicians, we like to make a diagnosis of MS as soon as possible so that we can start treatment right away. However, in some cases it may make sense not to rush into treatment when there is still uncertainty.”