Multiple Sclerosis Lecture Series: Diagnosis

Internet Enduring Material sponsored by Stanford University School of Medicine. Presented by the Stanford University School of Medicine's Department of Neurology and Center for Continuing Medical Education.

How is Multiple Sclerosis accurately diagnosed? This second lecture in the Multiple Sclerosis Series explores how to use a 4 step process to confirm if a patient has MS. Listen and examine 2 case studies and learn common barriers to a correct diagnosis. Learn why there are consequences to misdiagnosing MS in patients. This activity will appeal to all healthcare providers that want expert instruction about the diagnostic criteria, best practices in examination, careful interpretation of MRI scans, and common mistakes to avoid.

1. Apply a 4 step approach to confirming a Multiple Sclerosis diagnosis.
2. Summarize barriers to making a correct Multiple Sclerosis diagnosis.
3. Recognize the consequences of making a Multiple Sclerosis misdiagnosis.

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 0.75 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography
“Acting on Incidental Findings in Research Imaging | The BMJ.” Accessed May 10, 2022. https://www.bmj.com/content/351/bmj.h5190.
Aliaga, Esther Sánchez, and Frederik Barkhof. “Chapter 13 - MRI Mimics of Multiple Sclerosis.” In Handbook of Clinical Neurology, edited by Douglas S. Goodin, 122:291–316. Multiple Sclerosis and Related Disorders. Elsevier, 2014. https://doi.org/10.1016/B978-0-444-52001-2.00012-1.
Brownlee, Wallace J., Todd A. Hardy, Franz Fazekas, and David H. Miller. “Diagnosis of Multiple Sclerosis: Progress and Challenges.” The Lancet 389, no. 10076 (April 1, 2017): 1336–46. https://doi.org/10.1016/S0140-6736(16)30959-X.
Geraldes, Ruth, Maciej Jurynczyk, Giordani dos Passos, Alexander Prichler, Karen Chung, Marloes Hagens, Serena Ruggieri, et al. “Distinct Influence of Different Vascular Risk Factors on White Matter Brain Lesions in Multiple Sclerosis.” Journal of Neurology, Neurosurgery & Psychiatry 91, no. 4 (April 1, 2020): 388. https://doi.org/10.1136/jnnp-2019-322369.
Giovannoni, Gavin, Helmut Butzkueven, Suhayl Dhib-Jalbut, Jeremy Hobart, Gisela Kobelt, George Pepper, Maria Pia Sormani, Christoph Thalheim, Anthony Traboulsee, and Timothy Vollmer. “Brain Health: Time Matters in Multiple Sclerosis.” Multiple Sclerosis and Related Disorders 9 (September 1, 2016): S5–48. https://doi.org/10.1016/j.msard.2016.07.003.
Kingwell, Elaine, Alexander L. Leung, Elaine Roger, Pierre Duquette, Peter Rieckmann, and Helen Tremlett. “Factors Associated with Delay to Medical Recognition in Two Canadian Multiple Sclerosis Cohorts.” Journal of the Neurological Sciences 292, no. 1 (May 15, 2010): 57–62. https://doi.org/10.1016/j.jns.2010.02.007.
Miller, DH, BG Weinshenker, M Filippi, BL Banwell, JA Cohen, MS Freedman, SL Galetta, et al. “Differential Diagnosis of Suspected Multiple Sclerosis: A Consensus Approach.” Multiple Sclerosis Journal 14, no. 9 (November 1, 2008): 1157–74. https://doi.org/10.1177/1352458508096878.
Ojha, Piyush. “Optic Neuritis.” 17:57:32 UTC. https://www.slideshare.net/NeurologyKota/optic-neuritis-54229738.
Phillips, J. Theodore, T. Jock Murray, Alexander D. Rae-Grant, Robert J. Fox, Kedar R. Mahajan, Don J. Mahad, Marcus W. Koch, et al. Multiple Sclerosis and Related Disorders. Edited by Robert J. Fox, Alexander D. Rae-Grant, and Francois Bethoux. Springer Publishing Company, 2018. https://doi.org/10.1891/9780826125941.
Simonsen, Cecilia Smith, Heidi Øyen Flemmen, Trine Lauritzen, Pål Berg-Hansen, Stine Marit Moen, and Elisabeth Gulowsen Celius. “The Diagnostic Value of IgG Index versus Oligoclonal Bands in Cerebrospinal Fluid of Patients with Multiple Sclerosis.” Multiple Sclerosis Journal - Experimental, Translational and Clinical 6, no. 1 (January 1, 2020): 2055217319901291. https://doi.org/10.1177/2055217319901291.
Solomon, Andrew J. “Diagnosis, Differential Diagnosis, and Misdiagnosis of Multiple Sclerosis.” CONTINUUM: Lifelong Learning in Neurology 25, no. 3 (June 2019): 611. https://doi.org/10.1212/CON.0000000000000728.
Solomon, Andrew J., Dennis N. Bourdette, Anne H. Cross, Angela Applebee, Philip M. Skidd, Diantha B. Howard, Rebecca I. Spain, et al. “The Contemporary Spectrum of Multiple Sclerosis Misdiagnosis.” Neurology 87, no. 13 (September 27, 2016): 1393. https://doi.org/10.1212/WNL.0000000000003152.
Solomon, Andrew J., Eran P. Klein, and Dennis Bourdette. “‘Undiagnosing’ Multiple Sclerosis.” Neurology 78, no. 24 (June 12, 2012): 1986. https://doi.org/10.1212/WNL.0b013e318259e1b2.
Solomon, Andrew J., and Brian G. Weinshenker. “Misdiagnosis of Multiple Sclerosis: Frequency, Causes, Effects, and Prevention.” Current Neurology and Neuroscience Reports 13, no. 12 (October 20, 2013): 403. https://doi.org/10.1007/s11910-013-0403-y.
Thompson, Alan J., Brenda L. Banwell, Frederik Barkhof, William M. Carroll, Timothy Coetzee, Giancarlo Comi, Jorge Correale, et al. “Diagnosis of Multiple Sclerosis: 2017 Revisions of the McDonald Criteria.” The Lancet Neurology 17, no. 2 (February 1, 2018): 162–73. https://doi.org/10.1016/S1474-4422(17)30470-2.
Yamout, B., R. Alroughani, M. Al-Jumah, S. Khoury, N. Abouzeid, M. Dahdaleh, I. Alsharoqi, et al. “Consensus Guidelines for the Diagnosis and Treatment of Multiple Sclerosis.” Current Medical Research and Opinion 29, no. 6 (June 1, 2013): 611–21. https://doi.org/10.1185/03007995.2013.787979.

For activity related questions, please contact
     Name: Holly Meyer
     Title: CME Coordinator
     Email: [email protected]

For CME general questions, please contact 
     Email: [email protected]

Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Faculty Member Information

Role in activity

Name of Ineligible Company(s) / Nature of Relationship(s)

Lucas B. Kipp, MD
Stanford Hospital & Clinics

Course Director, Faculty

Grant or research support-Roche/Genentech|Grant or research support-Biogen Idec

Ruth Adewuya, MD, CHCP
Managing Director, Center for Continuing Medical Education
Stanford University School of Medicine

Planner

Nothing to disclose

Marilyn Mejia, BA
Education Design Coordinator
Stanford University

Planner

Nothing to disclose

Jamie McDonald, MD
Stanford Health Care

Reviewer

Nothing to disclose

This educational activity is supported in part by an educational grant from Novartis Pharmaceuticals Corporation.