Optimizing Localization in Multiple Sclerosis Diagnosis: Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN

WATCH TIME: 3 minutes

"It's important, I think, to think about localization and also look at the tests that people, that radiologists do. Always question and always make sure that you put the pieces [together] and they make sense to you."

Multiple sclerosis (MS), a chronic neurodegenerative autoimmune disease, has a complex clinical course that is recognized by inflammation, demyelination, and axonal degeneration. Diagnosing the condition most commonly involves localizing lesions in at least 2 separate areas of the central nervous system, which can include the brain, spinal cord, and optic nerves.¹ Over recent years, the field of MS has made significant progress in the number of treatments available for patients, allowing for more targeted care plans and overall better outcomes. Despite advancements in treatment and more knowledge of biomarkers, the field still experiences challenges with misdiagnosis in the clinical setting.

In recent years, there has been a growing body of research evidence on misdiagnosis and its prevalence in MS. Based on prior data from specialized MS centers, researchers reported that approximately 30% of cases originally referred for MS were diagnosed with a different disease.² Another study using data from 4 academic MS centers showed that over 50% of patients carried a misdiagnosis for at least 3 years, 70% received disease-modifying therapy, and 31% reported unnecessary morbidity as a direct result.³ These studies prove that a wide range of conditions can be mistaken for an MS diagnosis and if there is pressure for timely diagnosis, this may also increase the risk of misdiagnosis.⁴

During a session at the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee, Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN, an assistant professor at Hunter College Bellevue School of Nursing, presented on clinical pearls and the spinal cord. Following her talk, Ben-Zacharia, a nurse practitioner in New York City, sat down with NeurologyLive^® to discuss steps that providers can take to avoid an MS misdiagnosis when interpreting MRI results. In addition, Ben-Zacharia, who also serves as an assistant professor at Icahn School of Medicine at Mount Sinai, spoke about how collaboration between different specialists can help to improve the accuracy of medical diagnoses as well as the importance of verify findings with additional imaging sequences.

Click here for more coverage of CMSC 2024.

REFERENCES
1. Paul A, Comabella M, Gandhi R. Biomarkers in Multiple Sclerosis. Cold Spring Harb Perspect Med. 2019 Mar 1;9(3):a029058. doi: 10.1101/cshperspect.a029058. PMID: 29500303; PMCID: PMC6396336.
2. Yamout BI, Khoury SJ, Ayyoubi N, et al. Alternative diagnoses in patients referred to specialized centers for suspected MS. Mult Scler Relat Disord. 2017;18:85-89. doi:10.1016/j.msard.2017.09.016
3. Solomon AJ, Bourdette DN, Cross AH, et al. The contemporary spectrum of multiple sclerosis misdiagnosis: A multicenter study. Neurology. 2016;87(13):1393-1399. doi:10.1212/WNL.0000000000003152
4. Gaitán MI, Correale J. Multiple Sclerosis Misdiagnosis: A Persistent Problem to Solve. Front Neurol. 2019 May 7;10:466. doi: 10.3389/fneur.2019.00466. PMID: 31133970; PMCID: PMC6514150.