Diagnosing Multiple Sclerosis? First Rule Out NMOSD

In a story from Multiple Sclerosis News Today, multiple sclerosis is known for its variability- one patient’s experience may look nothing like a friend’s with the same disease. For this reason, the neurological disorder is notoriously difficult to diagnose, which is often found by eliminating other options rather than spotting it on its own.

Because there is no clear way to identify MS, diagnosis is done through a series of tests and diagnostic criteria which  tries to rule out other neurological disorders that have overlapping symptoms. This happens through tests such as MRI scans, neurological scams, medical history review, and spinal fluid analysis.
Now, a new study suggests that the metric used to diagnose MS be altered and be designed to first rule out neuromyelitis optics spectrum disorder (NMOSD). This disease similarly disrupts the functioning of the brain and spinal cord and has very similar markers and symptoms. As a result patients can get lumped into the MS sphere. MS is a the most common demyelinating disorder, so it’s more likely to be considered by doctors. The researchers believe ruling out NMOSD should be a mandatory part of the MS diagnosis process.

Multiple Sclerosis

Multiple sclerosis is a rare neurological disease that causes the immune system to attack nerve cells, damaging communication between the brain and body. The resultant symptoms vary greatly between patients, but include weakness, numbness, imbalance, lack of coordination, bladder control difficulty, and speech and vision issues. Patients may experience relapsing and remitting or progressive MS, meaning there are severe flare-ups followed by healthy periods, or constant symptoms that can deteriorate the patient’s health severely. While there’s not yet a cure, treatment is symptomatic.

Neuromyelitis Optics Spectrum Disorder

Neuromyelitis optics spectrum disorder (NMOSD) or Devic disease is a chronic neurological disorder know for inflammation of the spinal cord and optic nerve. Patient experience phases of symptoms and inflammation, followed by intervals of remission lasting from weeks to years. Symptoms vary depending on the individual, but include pain in the eye, spine, or limbs; paralysis, lack of bladder or bowel control, and sensory loss. While the symptoms often overlap with multiple sclerosis, patients with NMOSD usually experience worse cases of myelitis and optic neuritis, spinal fluid analysis usually lacks oligoclonal bands, and the brain MRI is more typical. While the disease can be treated and partially recover, some patients experience permanent vision and mobility loss.

Distinguishing The Two Diseases

In the recent research, scientists found a sizable number of patients who’d originally been misdiagnosed with MS before receiving a NMOSD diagnosis. This is an important distinction to get right because medications that help MS patients can worsen NMOSD symptoms. Using the Truven Health Analytics database, they found that out of 319,994 MS patients, 2,001 (0.62%) found later received a NMOSD diagnosis instead. This is only the patients that had already discovered the misdiagnosis as well. When researchers at the University of Kentucky Medical Center analyzed 54 patients individually, they found 4 of them (7.4%) were originally misdiagnosed with MS when they had NMOSD. This was notable because each of those patients met the MS criterion and had the characteristic MRI findings, yet did not have the disease.
While NMOSD is incurable, there are treatment options that help manage the symptoms to prevent it from progressing or relapsing. There are other treatment options for MS, but they are distinct, making diagnosis of utmost importance too.
Maddison Higgins, an advanced practicer provider who worked on the study, said to UKnow,
“It is essential to provide an accurate diagnosis and appropriate treatment so that patients can live the lives they planned to. We are fortunate to have the current medications that we do, and it is an extreme disservice to the patient if we don’t provide the accurate diagnosis to allow them maximum benefit from the appropriate treatment regimen.

What are your thoughts on the findings from this study? Share your stories, thoughts, and hopes with the Patient Worthy community!

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