Is Initial Misdiagnosis Associated with Reaching Disability Milestones in Patients with Multiple Sclerosis?

Alina Ivaniuk,Yuliia Solodovnikova,Tetiana Marusich,Anatoliy Son

doi:10.3390/medicina56040170

Alina Ivaniuk, Yuliia Solodovnikova + Show 2 more

Open Access

https://doi.org/10.3390/medicina56040170

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Abstract

Background and objectives: multiple sclerosis (MS) is a chronic demyelinating disorder of the CNS with a variable course and disability progression. The latter may be prevented with disease-modifying therapy (DMT). Initial misdiagnosis may postpone the use of DMT. There are no studies to explore whether initial misdiagnosis is indeed associated with a higher rate of reaching disability in MS patients. We aimed to investigate the association between initial misdiagnosis and reaching disability milestones in relapsing-remitting MS (RR-MS) patients. Materials and methods: Data from 128 RR-MS patients were retrospectively reviewed. EDSS 4 and EDSS 6 were chosen as disability milestones as those associated with a significant decrease in ambulation. Survival analysis was used, and Kaplan–Meier curves were generated to investigate how initial misdiagnosis affects reaching the defined milestones. Results: 53 patients (41.4%, 31 females, 22 males) were initially misdiagnosed. Initially misdiagnosed patients had a lesser risk of reaching EDSS 4 up to 11 years and EDSS 6 up to 22 years from the onset than non-misdiagnosed patients (p = 0.22 and p = 0.25 correspondingly). Median time to reaching EDSS 4 and 6 was eight years (95% CI 0.0–17.6) and 10 years (95% CI 4.25–20.75) in misdiagnosed and three years (95% CI 0.0–20.0 years) and five years (95% CI 0.0–13.73 years) in non-misdiagnosed patients correspondingly. Conclusions: Initially misdiagnosed RR-MS patients tended to reach disability milestones later than non-misdiagnosed ones, which might reflect an intrinsically milder disease. Individuals presenting with mild or non-specific symptoms suspicious of MS, must be deliberately managed.

Highlights

Multiple sclerosis (MS) is a chronic demyelinating immune-mediated disease of the CNS.Its presentation varies based on the CNS sites affected by demyelination
Collected data included the parameters that were identified by existing studies as the risk factors for disability progression in patients with Relapsing-remitting multiple sclerosis (RR-MS), such as patients’ sex, age of MS onset, smoking, disease-modifying therapy (DMT), BMI [1], along with years before the sustained EDSS 4 and 6 from MS onset, prehistory of an initial misdiagnosis, specification of the incorrect diagnosis and the neurologic symptoms the patients had at the first presentation to a physician
There was a trend for the initial misdiagnosis in patients with RR-MS to be associated with a lesser risk of reaching disability milestones compared to patients who were diagnosed correctly at the first encounter

Summary

Introduction

Multiple sclerosis (MS) is a chronic demyelinating immune-mediated disease of the CNS. Its presentation varies based on the CNS sites affected by demyelination. It can include sensory, motor, visual and/or balance disturbances, impairment of bowel and/or bladder function, disrupted emotions and cognition, etc. Global MS prevalence is estimated to be 50–300 per 100,000, with 2–3 million people affected worldwide [1]. MS causes a substantial social impact and economic burden since the incidence of the disease peaks at the mid-thirties (i.e., productive population), and it became the world-leading cause of non-traumatic neurological disability among young people [2]. Relapsing-remitting multiple sclerosis (RR-MS) is the most common MS phenotype accounting for 85%–90% of MS cases [3,4]

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