{'fraction_non_alphanumeric': 0.016361256544502618, 'fraction_numerical': 0.0058900523560209425, 'mean_word_length': 5.370833333333334, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Misdiagnosis of multiple sclerosis: Time for action

An early diagnosis of multiple sclerosis (MS) is essential to optimize long-term patient outcomes. There has been a concerted effort over the last two decades to continuously update and improve diagnostic criteria to allow earlier diagnosis.1 While a rapid diagnosis of MS is clearly desirable, this needs to be weighed against the risk of an incorrect diagnosis of MS in a patient with an alternative disorder or misdiagnosis. Varied clinical presentations, a broad differential diagnosis for relapsing or progressive symptoms, and diagnostic tests with high sensitivity but limited specificity mean an accurate diagnosis of MS can at times be challenging. Although first described in the pre-MRI era, a series of studies over the last decade have highlighted the frequency of MS misdiagnosis.2–4 In a survey of MS Specialists, >95% reported evaluating one or more patients misdiagnosed with MS in the previous 12 months,2 while a recent retrospective study found that almost one in five patients referred two specialist MS clinics with an established diagnosis of MS actually had an alternative diagnosis.4 These contemporary studies examining the issue of MS misdiagnosis have been from the United States, and whether there is international variation in rates of misdiagnosis, characteristics of patients misdiagnosed, or causes of misdiagnosis that are potentially related to differences in MS prevalence, service delivery and other health care system factors is unclear.