Multiple sclerosis diagnosis: Knowledge gaps and opportunities for educational intervention in neurologists in the United States

Author:

Solomon Andrew J1,Kaisey Marwa2,Krieger Stephen C3,Chahin Salim4,Naismith Robert T4,Weinstein Sarah M5ORCID,Shinohara Russell T5,Weinshenker Brian G6

Affiliation:

1. Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA

2. Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

3. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

4. Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA

5. Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

6. Department of Neurology, Mayo Clinic, Rochester, MN, USA

Abstract

Background: Few studies have addressed the results of educational efforts concerning proper use of McDonald criteria (MC) revisions outside multiple sclerosis (MS) subspecialty centers. Neurology residents and MS subspecialist neurologists demonstrated knowledge gaps for core elements of the MC in a recent prior study. Objective: To assess comprehension and application of MC core elements by non-MS specialist neurologists in the United States who routinely diagnose MS. Methods: Through a cross-sectional study design, a previously developed survey instrument was distributed online. Results: A total of 222 neurologists completed the study survey. Syndromes atypical for MS were frequently incorrectly considered “typical” MS presentations. Fourteen percent correctly identified definitions of both “periventricular” and “juxtacortical” lesions and 2% correctly applied these terms to 9/9 images. Twenty-four percent correctly identified all four central nervous system (CNS) regions for satisfaction of magnetic resonance imaging (MRI) dissemination in space. In two presented cases, 61% and 71% correctly identified dissemination in time (DIT) was not fulfilled, and 85% and 86% subsequently accepted nonspecific historical symptoms without objective evidence for DIT fulfillment. Conclusion: The high rate of knowledge deficiencies and application errors of core elements of the MC demonstrated by participants in this study raise pressing questions concerning adequacy of dissemination and educational efforts upon publication of revisions to MC.

Publisher

SAGE Publications

Subject

Neurology (clinical),Neurology

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