Jsmc-10317

REVISION OF MULTIPLE SCLEROSIS CASES ACCORDING TO NEW 2017 MCDONALD CRITERIA AMONG DIAGNOSED PATIENTS IN SULAIMANI CITY

Rzgar Hamid Abdula a, Mohammed Tahir Kurmanji b, Zana A.Mohammed b, and Sarwer Jamal Al-Bajalan b

a Department of Neurology of Shar Teaching Hospital, Kurdistan Region, Iraq. 

b Department of Medicine, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

Submitted: 15/9/2020; Accepted: 12/4/2021; Published: 21/9/2021

DOI Link: https://doi.org/10.17656/jsmc.10317 

ABSTRACT 

Background 

Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory disorder of the central nervous system. The diagnosis of Multiple sclerosis is challenging, owing to having a comprehensive list of differentials and mimickers.

Objectives 

To determine the frequency of misdiagnosed Multiple Sclerosis cases diagnosed among those patients in Sulaimani city.

Patients and and Methods

This retrospective observational study was conducted within a period between December 24th. 2019 and June 10th, 2020, on 106 already diagnosed patients. The study included patients diagnosed with the relapse-remitting form of multiple sclerosis. We excluded those patients with progressive forms of multiple sclerosis. We re-evaluated each patient in-depth and stratified the cases according to the diagnosis certainty based on the fulfillment of the 2017 McDonald Criteria. Finally, we returned those suspicious cases to the multiple sclerosis committee of Shar hospital to verify their final diagnosis. 

Results

Sixteen (16.9%) out of 106 patients, there was diagnostic uncertainty in which 6 (5.7%) of them received the confirmatory diagnosis of relapse-remitting multiple sclerosis by the committee, and 1(0.9%) patient considered secondary progressive multiple sclerosis. In the remaining 9 (8.4%) patients, we found the clinically isolated syndrome in 5 (4.7%) patients, solitary sclerosis in 1 (0.9%) patient, stroke with polycythemia rubra vera (PRV) in 1 (0.9%) patient, possible cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in 1 (0.9%) patient, and 1 (0.9 %) patient was undiagnosed. 

Conclusion

To sum up, the frequency of multiple sclerosis misdiagnosis was 8.4% in Sulaimani city, slightly lower than the other reporting centers.

KEYWORDS

Multiple sclerosis, 2017 McDonald criteria, Misdiagnosis, Clinically isolated syndrome, Relapse-remitting MS.

References 

1. Yamasaki R, Kira J-I. Multiple sclerosis. Adv Exp Med Biol. 2019;1190:217–47.

2. Leray E, Moreau T, Fromont A, Edan G. Epidemiology of multiple sclerosis. Rev Neurol (Paris). 2016;172(1):3–13.

3. Roostaei T, De Jager PL. Epidemiology and Genetics BT - Clinical Neuroimmunology: Multiple Sclerosis and Related Disorders. First edition. Rizvi SA, Cahill JF, Coyle PK, editors. Cham: Springer International Publishing; 2020. 71–87 p.

4. Gross R, Lublin F. Multiple Sclerosis: An Overview. In: Handbook of Relapsing-Remitting Multiple Sclerosis. First edition. Cham: Springer International Publishing; 2017. p. 1–16. 

5. Calabrese M, Gasperini C, Tortorella C, Schiavi G, Frisullo G, Ragonese P, et al. “Better explanations” in multiple sclerosis diagnostic workup: A 3-year longitudinal study. Neurology. 2019;92(22):e2527–37.

6. Sospedra M, Martin R. Immunology of multiple sclerosis. Semin Neurol. 2016;36(2):115–27.

7. Amezcua L, McCauley JL. Race and ethnicity on MS presentation and disease course. Mult Scler. 2020;26(5):561–7.

8. Ben-Zacharia AB, Mathewson G. Symptom Management in Multiple Sclerosis. In: Handbook of Relapsing-Remitting Multiple Sclerosis. First edition. Cham: Springer International Publishing; 2017. p. 115–34. 

9. Al-Araji A, Mohammed AI. Multiple sclerosis in Iraq: Does it have the same features encountered in Western countries? J Neurol Sci. 2005; 234(1):67–71. 

10. Rae-Grant AD. Unusual symptoms and syndromes in multiple sclerosis. Continuum (Minneap Minn). 2013;19:992–1006.

11. Rae-Grant AD. Author response: Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2019; 93(17):765. 

12. Reich DS, Lucchinetti CF, Calabresi PA. Multiple sclerosis. N Engl J Med. 2018;378(2):169–80.

13. Deshmukh VA, Tardif V, Lyssiotis CA, Green CC, Kerman B, Kim HJ, et al. A regenerative approach to the treatment of multiple sclerosis. Nature. 2013;502(7471):327–32.

14. Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis of multiple sclerosis: progress and challenges. Lancet. 2017;389(10076):1336–46.

15. Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73.

16. Hardmeier M, Leocani L, Fuhr P. A new role for evoked potentials in MS? Repurposing evoked potentials as biomarkers for clinical trials in MS. Mult Scler. 2017;23(10):1309–19.

17. Nourbakhsh B, Mowry EM. Multiple Sclerosis Risk Factors and Pathogenesis. Contin Lifelong Learn Neurol. 2019; 25(3):596–610.

18. McNicholas N, Hutchinson M, McGuigan C, Chataway J. 2017 McDonald diagnostic criteria: A review of the evidence. Mult Scler Relat Disord. 2018;24:48–54.

19. Solomon AJ, Naismith RT, Cross AH. Misdiagnosis of multiple sclerosis: Impact of the 2017 McDonald criteria on clinical practice. Neurology. 2019;92(1):26–33.

20. Hurwitz BJ. The diagnosis of multiple sclerosis and the clinical subtypes. Ann Indian Acad Neurol. 2009; 12(4):226–30. 

21. Solomon AJ. Diagnosis, Differential Diagnosis, and Misdiagnosis of Multiple Sclerosis. Contin Lifelong Learn Neurol. 2019; 25(3):611–35.

22. Filippi M, Rocca MA. Conventional MRI in multiple sclerosis. J Neuroimaging. 2007;17 Suppl 1:3S-9S.

23. Solomon AJ, Naismith RT, Cross AH. Misdiagnosis of multiple sclerosis. Impact 2017 McDonald criteria Clin Pract. 2019; 92(1):26–33.

24. Solomon AJ. Diagnosis, differential diagnosis, and misdiagnosis of multiple sclerosis. Continuum (Minneap Minn). 2019;25(3):611–35.

25. Solomon AJ, Klein EP, Bourdette D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012;78(24):1986–91.

26. McDonald I, Compston A. The symptoms and signs of multiple sclerosis. In: McAlpine's Multiple Sclerosis. Fourth edition. Elsevier; 2006. p. 287–346.

27. Arevalo O, Riascos R, Rabiei P, Kamali A, Nelson F. Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guide. J Comput Assist Tomogr. 2019; 43(1):1–12. 

28. Dekker I, Wattjes MP. Brain and Spinal Cord MR Imaging Features in Multiple Sclerosis and Variants. Neuroimaging Clin N Am. 2017; 27(2):205–27.

29. Ömerhoca, S., Akkaş, S. Y., & İçen, N. K. (2018). Multiple Sclerosis: Diagnosis and Differential Diagnosis. Noro psikiyatri arsivi, 55(Suppl 1), S1–S9. 

30. Brownlee WJ. Misdiagnosis of multiple sclerosis: If you have a hammer, everything looks like a nail? Neurology. 2019;92(1):15–6.

31. erraro D, On behalf of the RIREMS group (Rising Italian Researchers in Multiple Sclerosis), Franciotta D, Bedin R, Solaro C, Cocco E, et al. A multicenter study on the diagnostic significance of a single cerebrospinal fluid IgG band. J Neurol. 2017;264(5):973–8.

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