Frequency of NMOSD misdiagnosis in a cohort from Latin America: Impact and evaluation of different contributors
Journal
Multiple Sclerosis Journal
ISSN
1352-4585
1477-0970
Date Issued
2022
Author(s)
Edgar Carnero Contentti
Pablo A López
Juan Criniti
Ricardo Alonso
Berenice Silva
Geraldine Luetic
Edgar Patricio Correa-Díaz
Galleguillos Goiry, Lorna
Carlos Navas
Ibis Soto de Castillo
Fernando Diaz de Bedoya Hamuy
Fernando Gracia
Verónica Tkachuk
Brian G Weinshenker
Juan Ignacio Rojas
Type
Resource Types::text::journal::journal article
Abstract
<jats:sec><jats:title>Background:</jats:title><jats:p> Neuromyelitis optica spectrum disorder (NMOSD) misdiagnosis (i.e. the incorrect diagnosis of patients who truly have NMOSD) remains an issue in clinical practice. We determined the frequency and factors associated with NMOSD misdiagnosis in patients evaluated in a cohort from Latin America. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We retrospectively reviewed the medical records of patients with NMOSD, according to the 2015 diagnostic criteria, from referral clinics in six Latin American countries (Argentina, Chile, Paraguay, Colombia, Ecuador, and Venezuela). Diagnoses prior to NMOSD and ultimate diagnoses, demographic, clinical and paraclinical data, and treatment schemes were evaluated. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 469 patients presented with an established diagnosis of NMOSD (73.2% seropositive) and after evaluation, we determined that 56 (12%) patients had been initially misdiagnosed with a disease other than NMOSD. The most frequent alternative diagnoses were multiple sclerosis (MS; 66.1%), clinically isolated syndrome (17.9%), and cerebrovascular disease (3.6%). NMOSD misdiagnosis was determined by MS/NMOSD specialists in 33.9% of cases. An atypical MS syndrome was found in 86% of misdiagnosed patients, 50% had NMOSD red flags in brain and/or spinal magnetic resonance imaging (MRI), and 71.5% were prescribed disease-modifying drugs. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> NMOSD misdiagnosis is relatively frequent in Latin America (12%). Misapplication and misinterpretation of clinical and neuroradiological findings are relevant factors associated with misdiagnosis. </jats:p></jats:sec>
Subjects
latin american
;
misdiagnosis
;
nmosd
;
treatment
;
aquaporin 4
;
brain
;
diagnostic errors
;
humans
;
latin america
;
magnetic resonance imaging
;
multiple sclerosis
;
neuromyelitis optica
;
retrospective studies
;
alemtuzumab
;
aquaporin 4 antibody
;
azathioprine
;
dimethyl fumarate
;
eculizumab
;
fingolimod
;
immunoglobulin g
;
mycophenolate mofetil
;
natalizumab
;
ocrelizumab
;
oligoclonal band
;
rituximab
;
satralizumab
;
teriflunomide
;
aquaporin 4
;
adult
;
argentina
;
article
;
cerebrospinal fluid
;
cerebrovascular disease
;
chile
;
cohort analysis
;
colombia
;
demyelinating disease
;
ecuador
;
enzyme linked immunosorbent assay
;
female
;
glaucoma
;
health insurance
;
human
;
hypothalamus
;
immunofluorescence
;
immunosuppressive treatment
;
lumbar puncture
;
major clinical study
;
male
;
medical record
;
migraine
;
multiple sclerosis
;
myelooptic neuropathy
;
neuroimaging
;
neurologist
;
nuclear magnetic resonance imaging
;
optic neuritis
;
paraguay
;
retrospective study
;
sarcoidosis
;
venezuela
;
brain
;
diagnostic error
;
diagnostic imaging
;
multiple sclerosis
;
myelooptic neuropathy
;
pathology
;
procedures
;
south and central america