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To diagnose or not to diagnose? Timing is the question: balancing early diagnosis of multiple sclerosis with misdiagnosis

Multiple sclerosis (MS) is a neurodegenerative central nervous system (CNS) demyelinating disease with clinical and radiologic heterogeneity in which a pathognomonic biomarker has yet to be uncovered. Consequently, atypical presentations of MS can present a diagnostic challenge, especially in those patients who do not initially fit the classic picture of clinically isolated syndrome (CIS) and/or those who do not fulfill the 2010 McDonald criteria for MS [1,2]. Misdiagnosis can have both negative clinical and financial impacts on the patient and healthcare system [3]. Yet, there is increased pressure to make an earlier accurate diagnosis of MS due to the possibility for early initiation of disease-modifying therapies (DMT) to have improved clinical outcomes, including long-term disability reduction [4]. Finding the balance between making an early accurate diagnosis where timely intervention can commence, while avoiding the potential for misdiagnosis, remains an important topic for continual review.