Misdiagnosis and underdiagnosis of multiple sclerosis: A systematic review and meta-analysis

Mult Scler. 2024 Oct;30(11-12):1409-1422. doi: 10.1177/13524585241274527. Epub 2024 Sep 8.

Abstract

Background: Diagnostic errors in multiple sclerosis (MS) impact patients and healthcare systems.

Objectives: This study aimed to determine the prevalence of MS misdiagnosis and underdiagnosis, time delay in reaching a correct diagnosis and potential impact of sex.

Methods: Systematic review and meta-analysis on MS diagnostic errors.

Results: Out of 3910 studies, we included 62 for a qualitative synthesis and 24 for meta-analyses. Frequency of misdiagnosis (incorrect assignment of an MS diagnosis) ranged from 5% to 41%, with a pooled proportion based on six studies of 15% (95% CI: 9%-26%, n = 1621). The delay to rectify a misdiagnosis ranged from 0.3 to 15.9 years. Conversely, underdiagnosis (unrecognized diagnosis of MS) ranged from 3% to 58%, with a pooled proportion in four studies of 36% (95% CI: 20%-55%, n = 728). Pooling seven studies comprising 2851 individuals suggested a diagnostic delay to establish a correct MS diagnosis of 17.3 months (95% CI: 11.9-22.7) in patients underdiagnosed. In a meta-analysis of five studies, women were 2.1 times more likely to be misdiagnosed with MS compared to men (odds ratio, 95% CI: 1.53-2.86).

Conclusion: This study provides summary-level evidence for the high prevalence of MS misdiagnosis and underdiagnosis. Future studies are needed to understand the causes of these diagnostic challenges in MS care.

Keywords: Multiple sclerosis; diagnostic delay; diagnostic error; meta-analysis; misdiagnosis; systematic review; underdiagnosis.

Publication types

  • Systematic Review
  • Meta-Analysis

MeSH terms

  • Delayed Diagnosis
  • Diagnostic Errors*
  • Female
  • Humans
  • Male
  • Multiple Sclerosis* / diagnosis
  • Multiple Sclerosis* / epidemiology
  • Sex Factors