Multiple sclerosis is an unpredictable disease. MS events can come on without warning and go away just as unpredictably. For some patients, the disease has a steady progression. It can be frustrating for patients and their families to live with MS as patients and doctors try different treatment options to manage symptoms.
Even more difficult for patients is when their doctor gets the diagnosis completely wrong. This can happen in a couple of different ways, including diagnosing MS when the patient has a different medical condition, or diagnosing something else when the patient really has MS. This can delay treatment or submit the patient to unnecessary medical procedures that do nothing to treat their underlying condition.
If a doctor made the wrong MS diagnosis and you continued to suffer or your injuries were made worse because of the delays, you may have a claim for medical negligence. A medical malpractice lawsuit can help you get compensation for your injuries. If you are not sure whether you have an MS misdiagnosis claim or how much you can get for your injuries, talk to a medical malpractice law firm. Contact an experienced medical malpractice lawyer for legal advice about your case of misdiagnosed MS.
What Is Multiple Sclerosis?
Multiple sclerosis (MS) is a nervous system disease that affects a million people in the U.S. MS is considered to be an immune-mediated disease, where the body’s immune system attacks the central nervous system. MS can be mysterious to doctors and patients. It is chronic but unpredictable.
The damage caused by MS to the brain, spinal cord, and optic nerves interferes with nerve signal transmission, which causes the symptoms of MS. The immune system can attack certain cells and body structures, including nerve fibers, myelin (the protective sheath surrounding nerve fibers), and oligodendrocytes (myelin-producing cells)
According to the National Multiple Sclerosis Society, women are 3 times as likely to develop MS as men. However, anyone is at risk of developing MS at some point in their lifetimes. Statistically, MS is more common among white people of European descent. However, people of all backgrounds can be diagnosed with MS. Some environmental factors may increase the risk of MS, including smoking and low vitamin D.
Are There Different Types of MS?
There are 4 classifications of multiple sclerosis based on disease courses. MS can appear very differently in different patients. The disease courses of MS include:
- Clinically isolated syndrome (CIS)
- Relapsing-remitting MS (RRMS)
- Secondary progressive MS (SPMS)
- Primary progressive MS (PPMS)
Clinically isolated syndrome is generally the first symptomatic episode of neurologic problems caused by inflammation and demyelination. Symptoms of CIS can include:
- Weakness in one side of the body
- Tingling, numbness, or pain in the arms, legs, trunk, or face
- Difficulty walking, balancing, and lack of coordination
- Difficulty speaking or swallowing
- Vision problems
- Dizziness or vertigo
- Loss of sensation in the face
As the first appearance of MS symptoms, many patients go through an episode and recover normal function, thinking it is a transitory issue and not bothering to go see their doctors. However, after a first appearance, there is a high likelihood of repeated episodes. A magnetic resonance imaging (MRI) study can show brain lesions, which can help a doctor diagnose MS.
Doctors first have to determine whether the symptoms are caused by central nervous system (CNS) inflammation or something else. Doctors also have to determine the likelihood of demyelination. When CIS is accompanied by brain lesions detected using an MRI, the person has a much higher risk of developing MS.
Diagnosing high-risk CIS can help patients with early treatment of disease-modifying medication to delay or reduce the risk of further neurologic episodes.
The majority of patients with MS have relapsing-remitting MS (RRMS) at the onset. RRMS generally requires evidence of two or more CNS lesions (dissemination in space – DIS) and at different times (dissemination in time – DIT). Historical evidence of RRMS symptoms can include headache, fatigue, cognitive changes, pain and itching, emotional changes, and weakness.
Secondary progressive MS (SPMS) can occur in patients who were initially diagnosed with RRMS having secondary progressive MS after 15 to 20 years. This can result in worsening of the neurological symptoms of MS between attacks.
Less common than RRMS, primary progressive MS (PPMS) involves a gradual worsening of neurological symptoms. Diagnosis of PPMS can involve MRIs and spinal fluid evaluation and monitoring the patient over time.
How Do Doctors Diagnose Multiple Sclerosis?
The diagnostic process starts when a patient experiences a health problem and engages with the health care system. The doctor gathers information, including clinical history, medical history, family history, medications, and current medical concerns. A doctor may continue with a physical exam, diagnostic testing, imaging, and lab tests.
Doctors can then start with a working diagnosis and continue to gather information for a differential diagnosis or single diagnosis. The doctor then communicates the information to the patient to determine a treatment plan. Doctors may also refer the patient to another provider for a second opinion or refer the patient to a specialist.
An MS diagnosis should be made after a thorough evaluation. The diagnosis can include the exclusion of other causes of symptoms that appear to suggest MS. The diagnosis can be performed by a neurologist or other experienced healthcare provider with experience working with MS.
MRI imaging is a common tool used in diagnosing MS. Imaging findings that are not typical of MS can help avoid incorrectly attributing MRI lesions to MS. The MRI can show dissemination in space in lesions and dissemination in time, as well as new lesion formations. Additional testing can include blood tests, spinal fluid analysis, and other lab or clinical tests. However, there is no one test that definitively identifies (or rules out) MS.
McDonald Criteria Diagnosis
In 2001, medical professionals established criteria in association with the National MS Society of America. The criteria have been continually revised, most recently in 2017. According to the 2017 McDonald Criteria, clinical presentation and additional criteria to make an MS diagnosis include the following.
For people who experienced a typical attack/CIS at onset:
- 2 or more attacks and clinical evidence of 2 or more lesions or 2 or more attacks and clinical evidence of 1 lesion with clear historical evidence of prior attack involving lesion in a different location
- 2 or more attacks and clinical evidence of 1 lesion, and dissemination in space shown by:
- Additional clinical attack implicating different CNS site; or
- 1 or more MS-typical T2 lesions in 2 or more areas of CNS: periventricular, cortical, juxtacortical, infratentorial, or spinal cord
- 1 attack and clinical evidence of 2 or more lesions and dissemination in time shown by:
- Additional clinical attack, simultaneous presence of both enhancing and non-enhancing MS typical MRI lesions; or
- New T2 or enhancing MRI lesion compared to baseline scan (without regard to timing of baseline scan); or
- CSF oligoclonal bands
- 1 attack and clinical evidence of 1 lesion, dissemination in time criteria, and dissemination in space criteria
For people who have a steady progression of the disease since onset:
- 1 year of disease progression (retrospective or prospective) AND dissemination in space shown by at least two of:
- 1 or more MS-typical T2 lesions (periventricular, cortical, juxtacortical, or infratentorial)
- 2 or more T2 spinal cord lesions
- CSF oligoclonal bands
However, even with this MS criteria that doctors and patients have relied upon for years, doctors still get the diagnosis wrong. This can include making the wrong diagnosis, delayed diagnosis, or a misdiagnosis of another disease.
Treating Multiple Sclerosis
There is no cure for MS. Treatment options are generally intended to reduce the occurrence of relapses, reduce the severity, and delay the progression of the disease. Treatment options include:
- Corticosteroids to suppress the immune system and reduce inflammation
- Plasma exchange to treat flare-ups in relapsing patients
- Beta interferon drugs to regulate immune cells
- Glatiramer acetate
- Natalizumab to prevent immune system cells from entering the spinal cord and brain
Multiple Sclerosis and Misdiagnosis in the Medical Community
Unfortunately for MS patients and their families, MS is one of the most misdiagnosed nervous system diseases. When a patient is diagnosed with MS, they may rely on the doctor’s experience, training, and medical knowledge. When the doctor talks about the advances in medical science for the treatment of MS, the patient may feel confident that the doctor’s treatment plan is going to work.
Unfortunately, if the doctor gives the patient the wrong diagnosis, the treatments may do nothing to help the patient, and unnecessary medications and treatments may actually cause more harm than good. Atypical clinical syndromes for MS can include:
- Bilateral optic neuritis, severe optic neuritis, or poor recovery from optic neuritis
- Headache, with or without diplopia or visual obscuration
- Acute or subacute cognitive impairment
- Dizziness or vertigo without brainstem or cerebellar findings
- Sensory loss in extremities without a clear CNS pattern
- Complete transverse myelopathy
In the medical journal Multiple Sclerosis and Related Disorder, a survey of patients diagnosed with multiple sclerosis (MS) found that nearly 20% of patients were misdiagnosed and did not have the disease. Misdiagnosed patients were exposed to high-risk medications and suffered adverse drug events, as well as delays in correct treatment for the patient’s conditions. The most common alternative diagnoses were:
- Radiologically isolated syndrome
According to another study in the journal Neurology, “misdiagnosis of multiple sclerosis remains a problem in contemporary clinical practice. Studies indicate that misdiagnosed patients are often exposed to prolonged unnecessary health care risks and morbidity.”
“Studies have indicated that, of all new referrals to MS subspecialty centers with a question of MS diagnosis,” the researchers found, “30%–67% were ultimately determined not to have MS.” Of patients who were misdiagnosed, over half were incorrectly diagnosed for at least 3 years!
Even though the 2017 diagnostic criteria were revised to integrate issues relating to misdiagnosis, it may not apply to atypical clinical presentations. Further evaluation and monitoring may be preferred to an immediate diagnosis of MS.
Doctors treating patients with presentations that appear similar to MS have to be aware of alternative diagnoses, including functional neurological disorder, migraine, vascular disease, and uncommon inflammatory, infections, and metabolic disorders.
Unnecessary Disease-Modifying Therapy
When patients are misdiagnosed with MS, doctors may prescribe treatment appropriate for MS but harmful for patients without MS. This includes disease-modifying therapy (DMT). There are many different types of DMTs for patients, including daily medications, intravenous drugs, and other therapies. Side effects of DMTs and adverse events can include:
- Flu-like symptoms
- Reactions at the injection site
- Shortness of breath
- Respiratory infection
- Nausea and vomiting
- Joint pain
- High blood pressure
- Abnormal liver function tests
- Lower white blood cell count
When Is a Doctor at Fault for a Misdiagnosis?
When the doctor gets the wrong diagnosis, it can cause serious harm and injury to the patient. Under medical malpractice law, for a patient to win a claim against a negligent doctor, the patient has to prove:
- The doctor owed the patient a duty of care
- The doctor deviated from medical standards
- The deviation caused the patient’s misdiagnosis
- The patient suffered injury and harm as a result
An example of a doctor making the wrong diagnosis by deviating from medical standards could include failing to properly apply the McDonald criteria for diagnosing MS. The doctor may also misinterpret MRIs or spinal fluid tests. A doctor could also fail to provide the appropriate level of care by failing to order proper tests to rule out other medical conditions, favoring the MS diagnosis.
How Can I File a Malpractice Claim Against the Doctor Who Misdiagnosed MS?
If you were diagnosed with MS and the treatments are not working or you feel worse under the DMT treatments for MS, there is a chance you have the wrong diagnosis. You can always express your concerns to your doctor or get a second opinion.
If you were misdiagnosed with MS and suffered unnecessary injuries and harmful medical treatment, you may be able to file a malpractice claim against the negligent doctor. Medical malpractice lawyers, like the trial attorneys at Gilman & Bedigian, have extensive experience in misdiagnosis claims because they focus on just these types of cases. They can review your case, have medical experts review your records, and find out what was the cause of your misdiagnosis injuries.
With the right legal team on your side, you will have the resources to help you recover damages after suffering a false MS diagnosis. Contact Gilman & Bedigian online or at 800-529-6162 for a free consultation.