多发性硬化症的频谱误诊的时代麦当劳标准:一项多中心研究(PL01.003)

文摘

客观的:描述患者误诊为多发性硬化症(MS),假设误诊的常见原因。背景:误诊的女士是一个持续的如果不是日益严重的问题,尽管,也许是因为,影像学诊断技术的提高。很少有研究当代特征光谱的误诊。方法女士:在13个月,神经学家在四个学术中心提交有关个别病人的资料他们已经评估,决心与女士误诊。结果:110年误诊患者,51 (46 [percnt])有“明确的”和59 (54 [percnt])“可能”误诊根据研究的定义。最常见的主要诊断偏头痛单独或结合其他诊断24 (21 [percnt]),纤维肌痛症16 (15 [percnt]),非特异性或non-localizing神经症状与MRI异常13 (12 [percnt]),和转换或心因性障碍12 (11 [percnt])。27个额外的诊断报告。32 (29 [percnt])的患者之间进行误诊3 - 9年,29 (26 [percnt]) 10 - 20年。77 (70 [percnt])修改了疾病治疗,包括natalizumab 14 (13 [percnt]), 2米托蒽醌(2 [percnt]),环磷酰胺1 (1 [percnt])。4 [percnt])参加了一个女士的研究治疗。79年(72 [percnt])的患者,参与神经学家指出,有证据表明早期错失的机会做出正确的诊断和34 (31 [percnt])遭受不必要的发病率直接导致误诊。不当归因的脱髓鞘疾病症状误诊导致72年(65 [percnt])病人,并依靠历史的症状没有确凿的证据证明损害的客观证据53 (48 [percnt])。过度依赖MRI异常满足传播在空间特异性的神经系统症状患者误诊导致66年(60 [percnt])。结论:误诊的女士是一个常见的问题,可能导致治疗相关的以及心理的发病率。误解和误用的医学临床和影像学诊断标准是误诊的重要原因。

披露:所罗门博士已经收到个人赔偿干草市场媒体作为一个演讲者。Bourdette博士已经收到个人活动与补偿Idec, Serono,神经科学和梯瓦扬声器/教师。交叉博士已经收到个人活动与补偿Idec, Genzyme公司,葛兰素史克,Inc .,霍夫曼-罗氏公司,Teva神经科学、诺华、Questcor。阿普尔比连锁餐厅没有披露博士。Skidd博士没有披露。博士霍华德没有披露。西班牙没有披露博士。米歇尔博士卡梅伦已收到补偿活动Acorda疗法,MD咨询顾问和“重新行走”。金医生已收到个人补偿活动梯瓦制药和Genzyme。博士质量没有披露。 Dr. Yadav has received personal compensation for activities with Novartis as a consultant. Dr. Yadav has received research support from Biogen Idec. Dr. Whitham has received personal compensation for activities with Chugai Pharmaceutical as a data safety monitoring board member. Dr. Longbrake has received personal compensation for activities with Genzyme. Dr. Naismith received personal compensation for activities with Alkermes, Acorda, Bayer, Biogen Idec, Genentech Inc., Genzyme Corporation, EMD Serono, Novartis, and Questcor as a consultant and from Acorda Therapeutics and Genzyme Corporation as a speaker Dr. Wu has received personal compensation for activities with Biogen Idec and Pfizer Inc. Dr. Parks has received personal compensation for activities with BiogenIdec and Novartis as an advisory board member. Dr. Wingerchuk has received personal compensation for serving on a clinical trial adjudication committee for Medimmune. Dr. Wingerchuk has received personal compensation in an editorial capacity for The Neurologist. Dr. Wingerchuk has received research su Dr. Rabin has nothing to disclose. Dr. Toledano has nothing to disclose. Dr. Tobin has nothing to disclose. Dr. Kantarci has nothing to disclose. Dr. Carter has received personal compensation for activities with EMD-Serono, University of Louisville and Omnicare, Inc. for serving as a member of the board and various other activities. Dr. Carter has received research support from the Sanofi, Genzyme Dr. Keegan has received research support from Terumo BCT. Dr. Weinshenker has received personal compensation for activities with Novartis, Biogen Idec, Mitsubishi Pharmaceuticals, MedImmune Pharmaceuticals, Chugai, and Chord as a consultant. Dr. Weinshenker has received royalty payments from RSR Ltd. and Oxford