Department of Neurology, University of Kentucky Medical Center, Kentucky Neuroscience Center, 740 S Limestone Dr, Lexington, KY 40536, USA.
Department of Neurology, University of Kentucky Medical Center, Kentucky Neuroscience Center, 740 S Limestone Dr, Lexington, KY 40536, USA.
Mult Scler Relat Disord. 2020 May;40:101949. doi: 10.1016/j.msard.2020.101949. Epub 2020 Jan 15.
The symptoms of multiple sclerosis (MS) can overlap with neuromyelitis optica spectrum disorder (NMOSD). Although testing is available for aquaporin 4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, screening for NMOSD is recommended but not mandatory to establish a diagnosis of MS.
We queried 319,994 individuals who filed claims for MS and NMOSD in a Truven Health Analytics (THA) database and had at least one year of uninterrupted health insurance coverage. Of this cohort, 2001 (0.62%) were diagnosed as having NMOSD after an initial diagnosis of MS, based on ICD 9/10 codes. Since THA only offers claims-based data, we initiated an individual patient-based data search at our medical center to screen for potential misdiagnoses. We identified 4/54 (7.4%) NMOSD cases that were initially diagnosed as having MS.
The results from our small study have significant implications--symptoms, clinical presentation or classic radiological findings perhaps cannot reliably separate MS from NMOSD. If our study findings can be replicated, guidelines to diagnose MS ought to recommend that NMOSD be excluded first despite typical clinical and radiological findings pointing to MS.
多发性硬化症（MS）的症状可能与视神经脊髓炎谱系障碍（NMOSD）重叠。虽然可以检测水通道蛋白 4（AQP4）和髓鞘少突胶质细胞糖蛋白（MOG）抗体，但为了确诊 MS，建议筛查 NMOSD，但并非强制性的。
我们在 Truven Health Analytics（THA）数据库中查询了 319944 名曾被诊断为 MS 和 NMOSD 的患者，并对其进行了至少一年的不间断医疗保险覆盖。在该队列中，根据 ICD 9/10 代码，2001 例（0.62%）在最初诊断为 MS 后被诊断为 NMOSD。由于 THA 仅提供基于索赔的数据，我们在我们的医疗中心启动了一项基于个体患者的数据搜索，以筛查潜在的误诊。我们发现了 4/54（7.4%）最初被诊断为 MS 的 NMOSD 病例。
我们的小研究结果具有重要意义——症状、临床表现或典型的影像学发现可能无法可靠地区分 MS 与 NMOSD。如果我们的研究结果可以得到复制，那么诊断 MS 的指南应该建议首先排除 NMOSD，尽管典型的临床和影像学发现指向 MS。
