/ by Jay Avasarala, MD, PhD
Diagnosing multiple sclerosis (MS), a disease that gradually destroys the protective covering of nerve cells in the brain and spinal cord, is a marathon, not a sprint. This is especially true because misdiagnosis of MS is common, which can have a significant impact on your quality of life as well as your wallet.
Let's break down why MS is misdiagnosed and what can be done to try to prevent misdiagnosis:
Why is MS misdiagnosed ?
The prevalence of MS misdiagnosis is unknown because it is not a reportable disease. Common misdiagnoses include conditions such as:
Many diseases can also mimic MS, including vasculitis, infection, neuromyelitis optica, among others.
There are a couple common causes of the misdiagnosis of MS:
- Your doctor may not apply the proper criteria to diagnose you.
- Your doctor may rely too much on MRI changes in your brain/spinal cord.
Remember, you can always ask to be referred to a multiple sclerosis specialist to seek further assistance.
How can we ensure an accurate diagnosis (and prevent misdiagnosis)?
An extensive history from you, the patient, is always the first step. Only you can provide key information that would otherwise remain obscured. Your history provides the most pieces to the puzzle.
A thorough neurological physical examination is the next step. If there is an indication based on history and physical exam, an MRI of the brain and spinal cord will likely follow to evaluate for evidence of demyelinating lesions, which appear in patients with MS. Your doctor may or may not choose to do a lumbar puncture. Serum testing for Neuromyelitis Optica Spectrum Disorder (NMOSD) antibodies and other autoimmune conditions that can mimic MS is also done on a case-by-case basis.
Once the imaging and lumbar puncture are complete, your doctor will interpret your results using the McDonald Criteria, which is the standard for diagnosing MS.