Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey

Rafid Mustafa; Eoin P Flanagan; Dustin J Duffy; Brian G Weinshenker; M Mateo Paz Soldán; Amy Kunchok; Marwa Kaisey; Andrew J Solomon

doi:10.1016/j.jns.2023.120781

Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey

J Neurol Sci. 2023 Oct 15:453:120781. doi: 10.1016/j.jns.2023.120781. Epub 2023 Sep 1.

Authors

Rafid Mustafa¹, Eoin P Flanagan², Dustin J Duffy³, Brian G Weinshenker⁴, M Mateo Paz Soldán⁵, Amy Kunchok⁶, Marwa Kaisey⁷, Andrew J Solomon⁸

Affiliations

¹ Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA. Electronic address: mustafa.rafid@mayo.edu.
² Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA.
³ Biostatistics, Mayo Clinic College of Medicine & Science, Rochester, MN, USA.
⁴ Department of Neurology, University of Virginia Health, Charlottesville, VA, USA.
⁵ Department of Neurology, University of Utah Health, Salt Lake City, UT, USA.
⁶ Department of Neurology, Mellen Center for Multiple Sclerosis, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
⁷ Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁸ Department of Neurological Sciences, Larner College of Medicine at The University of Vermont Medical Center, Burlington, VT, USA.

PMID: 37688999
DOI: 10.1016/j.jns.2023.120781

Abstract

Background: There is limited evidence and lack of guidelines for diagnostic laboratory evaluation of patients with possible multiple sclerosis (MS).

Objective: To survey neurologists on their practice of laboratory testing in patients with possible MS.

Methods: An online survey was developed to query the frequency of serum and cerebrospinal fluid (CSF) studies ordered in the routine evaluation of patients with possible MS, and in three hypothetical clinical cases. Non-MS specialist neurologists who evaluate patients for MS in their practice were invited to participate by MedSurvey (a medical market research company).

Results: The survey was completed by 190 neurologists. A mean of 17.2 (SD: 17.0) tests in serum and CSF were reported "always" ordered in the evaluation of patients with possible MS. CSF oligoclonal bands was the most frequently selected ("always" among 73.7% of participants). Antinuclear antibody (43.2%), erythrocyte sedimentation rate (34.2%), and thyroid stimulating hormone (31.6%) were also among the most frequently ordered.

Discussion: Extensive laboratory evaluations are often completed in the evaluation of possible MS. However, many of these tests have poor specificity and false positive results could yield unnecessary increased costs, diagnostic delay, and potentially misdiagnosis. Further research is needed to identify optimal laboratory approaches for possible MS.

Keywords: Costs; Misdiagnosis; Multiple sclerosis; Testing; Utilization.