Christina Applegate’s MS misdiagnosis after 5 years of treatment exposes alarming medical reality
She recalled that her MRIs clearly showed around 30 lesions, but said her neurologist identified a different feature — which she described as a “string” — that led to the conclusion that she did not have MS.
“So I’m back at square one [and] don’t know what’s going on with me.”
Why MS can be misdiagnosed
Dr. Marwa Kaisey, an associate professor of neurology at Cedars-Sinai in Los Angeles, said during a follow-up “MeSsy” podcast episode that misdiagnosis of MS is “fairly common.”
In a study of patients referred to MS clinics at UCLA and Cedars-Sinai, Kaisey — who has not treated Applegate — said she found that nearly one in five who arrived with an MS diagnosis ultimately did not have the disease.
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“Some [had been diagnosed] for decades,” she said. “And a majority of them were on medication to treat their MS.”
The primary challenge, according to the doctor, is that there is no single test for MS. “It’s not like we have something like a pregnancy test that says, yes, you have it, no, you don’t.”
Instead, Kaisey said, “It’s a list of criteria, some of which remain a little bit subjective.”
New clues on brain scans
Most misdiagnosed patients did have some type of white matter spots, or lesions, on their MRI scans, Kaisey noted, but they had a different cause that was not MS.
Newer imaging techniques may help doctors distinguish MS lesions from white matter spots caused by other conditions.
Most misdiagnosed patients did have some type of white matter spots, or lesions, on their MRI scans, Kaisey noted, but they had a different cause that was not MS. (iStock)
Kaisey pointed to the “central vein sign,” an MRI finding that looks for small blood vessels running through the center of lesions, which is a characteristic associated with MS. The sign was incorporated into updated MS diagnostic criteria to help doctors determine whether white matter lesions are consistent with the disease.
Richard Ransohoff, MD, a Boston-based neurologist who sits on the Board of Directors for the American Brain Foundation, called the central vein sign “a real step forward” in distinguishing MS lesions from other abnormalities.
“Things are getting better, and even in the time that Ms. Applegate has been having her symptoms and her evaluation, things have gotten better,” said Ransohoff, who also has not treated the actress.
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Many of the symptoms of MS — such as tingling or numbness in the feet, fatigue and brain fog — are very common in other conditions as well, according to both neurologists.
“To distinguish MS from its mimics can be challenging, and doctors, even with the best intentions … can sometimes still get it wrong,” Kaisey said. “To diagnose MS, we need a symptom that’s kind of very specific to MS, and we also need the MRI that looks like MS.”
Despite the potential for diagnostic uncertainty, doctors emphasized that the outlook for people who do have MS has improved dramatically. (iStock)
Kaisey said she has found that being “undiagnosed” with MS can be even harder than receiving the initial diagnosis, particularly when the disease has become intertwined with someone’s identity, family and community.
“So to suddenly take that away, I think it’s earth-shattering. It’s life-changing in a huge way.”
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The neurologist emphasized that patients should feel comfortable asking questions and getting a second opinion.
“Don’t be afraid to do that, especially if something inside is telling you that you need to dig a little deeper,” she advised.
MS-mimicking conditions
Ransohoff reiterated that MS misdiagnoses are common. “It’s a tough diagnosis, and there is no single element in the diagnostic process that tells you with 100% certainty that it is MS,” he told Fox News Digital.
The neurologist said even after a diagnosis, doctors should “keep an open mind” and be willing to reconsider.
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“If things start going differently from your expectations, if the person begins to have symptoms that really don’t fit in with MS, or they don’t respond to treatment, then you really start to put on your thinking cap and say, ‘What else could this be?’”
“It requires the ultimate in humility as a physician. You simply have to say there are certain things we know and certain things we don’t know.”
Christina Applegate attends the 28th Annual Critics Choice Awards at Fairmont Century Plaza on Jan. 15, 2023, in Los Angeles, California. The actress, 54, shared her misdiagnosis during an Oct. 20 episode of her podcast, “MeSsy.” (Getty Images for Critics Choice Association)
Classic early MS symptoms tend to appear relatively quickly, persist for weeks and then recede, according to Ransohoff.
Anything producing a similar pattern can potentially mimic the disease. Some of those conditions may include certain strokes in younger people, neuromyelitis optica spectrum disease (a rare autoimmune disease of the central nervous system), MOG antibody disease (a rare autoimmune inflammatory disorder), lupus and migraine, he said.
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Migraine is one of the most common alternative diagnoses, both neurologists agreed.
Kaisey noted that migraine can also produce MRI abnormalities in the form of white spots, although they are usually smaller and in a different shape and location.
“Facing the unknown when you feel crappy is a very tough road to go.”
Article source: https://www.foxnews.com/health/christina-applegate-ms-misdiagnosis-5-years-treatment-exposes-alarming-medical-reality