There is a push to diagnose multiple sclerosis (MS) earlier, which can lead to misdiagnosis if the diagnostic criteria aren’t used properly, explained Patricia K. Coyle, MD, director of the MS Comprehensive Care Center and professor of neurology at Stony Brook University Neurosciences Institute.
There is a push to diagnose multiple sclerosis (MS) earlier, which can lead to misdiagnosis if the diagnostic criteria aren’t used properly. As a result, some people are being told they have MS, when they actually don’t, explained Patricia K. Coyle, MD, director of the MS Comprehensive Care Center and professor of neurology at Stony Brook University Neurosciences Institute.
What are some of the diagnostic issues that could make it difficult to make an accurate diagnosis of multiple sclerosis?
Well, first of all, there's a push to diagnose very early so appropriate treatment can be used. Secondly, there's not a good understanding of the 2017 revised McDonald diagnostic criteria, which are the formal diagnostic criteria. They're actually quite useful. I think they're quite easy to understand. We need to be using them on a regular basis.
Thirdly, there is a true misdiagnosis rate. So, the diagnostic criteria are not being applied. And I think this argues for a very robust workup and being aware that people are being told they have MS and they don't, and there's actually some harm being done. So, I think the diagnosis everything starts with diagnosis, and we need to take it very seriously.
How can providers better overcome diagnostic issues to make an earlier diagnosis of multiple sclerosis?
One key is a thorough, robust workup. That means you create a differential diagnosis; you do appropriate bloodwork. For example, anyone who is presenting with possible relapsing ms, I believe you need to check them for IgG [immunoglobulin] to aquaporin-4 in the blood. You need to check them to for IgG to MOG [myelin oligodendrocyte glycoprotein] in the blood to rule out seropositive NMO [neuromyelitis optica] spectrum disorder, and MOGAD—MOG-associated disorders. That should be routinely done.
We need a robust workup. They need MRI imaging, not just of the brain, but I believe of the cervical and the thoracic spinal cord, the other part of the central nervous system, actually imaging down to the conus.
And thirdly, our center routinely lumbar punctures. We look at cerebral spinal fluid. We're looking for CSF [cerebral spinal fluid] oligoclonal band specificity. That's independent of the MRI pattern. It is extraordinarily helpful to assure that you have MS and not another diagnosis. So, I think a thorough workup laboratory evaluation is key.
The Push for Fair Pricing and Reform in Pharmacy Benefit Management
April 3rd 2025Amid growing legislative pressures and industry debates, pharmacy benefit managers (PBMs) are exploring new strategies to enhance transparency, reduce patient costs, and navigate the evolving healthcare landscape.
Read More
Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care
February 25th 2025On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.
Listen
Using AI-Driven Strategies to Optimize Specialty Drug Costs, Manage Polypharmacy
April 2nd 2025As health care costs continue to rise, artificial intelligence (AI)-driven solutions are emerging as a powerful tool for managing specialty drug spending and polypharmacy risks, as showcased in recent research presented at the Academy of Managed Care Pharmacy 2025 conference.
Read More
How Recent Federal Policy Changes Are Shaping Managed Care Pharmacy
April 2nd 2025Federal legislative and regulatory changes are reshaping pharmacy practice, with key challenges in government funding, pharmacy benefit manager reform, and health care policy shifts—topics explored by experts at the Academy of Managed Care Pharmacy's annual meeting.
Read More
The IRA’s Unintended Consequences for Drug Pricing and Coverage
April 2nd 2025The Inflation Reduction Act (IRA) may be restricting Medicare Part D formularies, increasing patient costs, and stifling pharmaceutical innovation, experts warned at the Academy of Managed Care Pharmacy 2025 annual meeting.
Read More