Diagnóstico erróneo en esclerosis múltiple: causas y consecuencias

ResumenIntroducción: El diagnóstico erróneo (DE) en esclerosis múltiple (EM) es preocupante y persiste al no existir un marcador específico para esta enfermedad.Objetivosa) Referir resultados de evaluaciones neurológicas de pacientes con diagnóstico de EM, antes de su inclusión en estudio BEYOND; b) evaluar si se observaba DE en EM y las causas que llevaron al mismo, y c) considerar las consecuencias que causa el DE en EM.Material y métodosSe analizó retrospectivamente a 67 pacientes enviados por neurólogos de otras instituciones hospitalarias al Servicio Neurología Policlínica Bancaria. Se realizó examen clínico/neurológico y evaluación de estudios de pacientes recibidos, evaluando si cumplían criterios de inclusión y exclusión (CICE) del BEYOND, siendo principal CI pacientes con EM recaída remisión (EMRR) cumpliendo criterios de McDonald 2001.ResultadosVeintidós pacientes (32,8%) no eran EM; 45 pacientes (67,2%) cumplían criterios para EM: 18 (26,8%) fueron (EMRR), 24 (35,8%) EM secundaria progresiva t 3 (4,4%) primaria progresiva.ConclusionesEl 32,8% no eran pacientes con EM, indicando la existencia de un DE. El DE en EM es un problema con graves consecuencias para los pacientes y su familia, se agrava al establecer un tratamiento y afecta a los sistemas de salud que la financian, generando un impacto económico en ellos, debido a los altos costos que tiene el tratamiento de esta enfermedad.

IntroductionThe misdiagnosis of multiple sclerosis (MS) is a concern and is due to the lack of a specific marker of the disease.Objectivesa) To discuss the findings of the neurological assessment of patients with multiple sclerosis before being included in the BEYOND Trial; b) To evaluate whether misdiagnosis was observed among patients with multiple sclerosis, and the reasons thereof; c) To consider the effects of misdiagnosis on multiple sclerosis. Materials andMaterial and methods67 patients referred by neurologists of other medical centers to the Neurology Service of Policlínica Bancaria were analized retrospectively. A clinical and neurological examination of the patients, and an evaluation of previous tests, were made at our center, based on whether patients fulfilled the inclusion and exclusion criteria of the BEYOND Trial, or not. One of the main inclusion criteria for patient enrollment was presenting with relapsing/remitting multiple sclerosis (RRMS) based on McDonalds's 2001 criteria.Results22 patients (32.8%) did not have multiple sclerosis; 45 (67.2%) met the diagnostic criteria for multiple sclerosis; 18 (26.8%) presented with relapsing/remitting multiple sclerosis; 24 (35.8%) had secondary progressive multiple sclerosis; and 3 (4.4%) had primary progressive multiple sclerosisConclusions32.8% were not patients with multiple sclerosis, which suggests misdiagnosis. Misdiagnosis of multiple sclerosis is a problem with serious consequences for patients and their families, and its negative impact increases when treatment is instituted, with adverse effects on the healthcare system because of the high cost of this disease.