1 in 5 Multiple Sclerosis Patients Misdiagnosed

By Pat Anson, PNN Editor

Nearly one in five patients who are told they have multiple sclerosis are misdiagnosed with the autoimmune disease, according to a new study of patients referred to two MS treatment centers in Los Angeles. The patients spent an average of four years being treated for MS before receiving a correct diagnosis.

MS is a chronic disease that attacks the body’s central nervous system, causing pain, numbness, difficulty walking, paralysis, loss of vision, and fatigue. The symptoms are similar to those of several other chronic conditions – including neuropathy, migraine and fibromyalgia – which often leads to a misdiagnosis.

Researchers at the Cedars-Sinai Multiple Sclerosis and Neuroimmunology Center analyzed the cases of 241 patients who had been diagnosed by other physicians and then referred to the Cedars-Sinai or UCLA MS clinics.

bigstock-Tablet-with-the-diagnosis-mult-62746568.jpg

Their findings, published in the journal Multiple Sclerosis and Related Disorders, indicate that 43 of the 241 patients (18%) with a previous diagnosis of MS did not meet the criteria for the disease.

"The diagnosis of MS is tricky. Both the symptoms and MRI testing results can look like other conditions, such as stroke, migraines and vitamin B12 deficiency," said lead author Marwa Kaisey, MD. "You have to rule out any other diagnoses, and it's not a perfect science."

The most common correct diagnoses was migraine (16%), radiologically isolated syndrome (RIS) (9%), spondylopathy (7%), and neuropathy (7%). RIS is a condition in which patients do not experience symptoms of MS even though their imaging tests look similar to those of MS patients.

The misdiagnosed patients received approximately 110 patient-years of unnecessary MS disease modifying drugs. Nearly half received medications that carry a known risk of developing progressive multifocal leukoencephalopathy, a potentially fatal brain infection.

"I've seen patients suffering side effects from the medication they were taking for a disease they didn't have," Kaisey said. "Meanwhile, they weren't getting treatment for what they did have. The cost to the patient is huge — medically, psychologically, financially."

The cost of disease modifying medications for an MS patient in the U.S. exceeds $50,000 a year. Investigators estimated that the unnecessary treatments identified in this study alone cost almost $10 million. 

Researchers hope the results of the study will lead to new biomarkers and improved imaging techniques to help prevent future MS misdiagnoses.

A similar study in 2016 also found that MS patients were often misdiagnosed. One third of the patients were misdiagnosed for a decade or longer, most took unnecessary and potentially harmful medication to treat a disease they didn't have, and some even participated in clinical trials for experimental MS therapies. About a third suffered from morbid thoughts of death.

Virtual Reality Relieves Pain in Hospitalized Patients

By Pat Anson, Editor

Virtual reality therapy significantly reduced both acute and chronic pain in hospitalized patients, according to a new study that adds to a growing body of evidence that virtual reality (VR) can give temporary relief to pain patients. The study is published online in the journal JMIR Mental Health.

Researchers at Cedars-Sinai Medical Center in Los Angeles enrolled 100 patients in the study who had an average pain score of 5.4 on a pain scale of zero to 10.

They suffered from a wide variety of conditions, including gastrointestinal, cardiac, neurological and post-surgical pain.

Fifty patients watched a 15-minute nature video on a computer screen that included mountain scenes and running streams, accompanied by calming music.

The other 50 patients wore virtual reality goggles to watch a 15-minute animated game called Pain RelieVR, which was specifically designed to treat patients who are bed bound or have limited mobility.

The game takes place in a fantasy world where users shoot imaginary balls at a wide range of moving objects by maneuvering their heads toward the targets. The game also uses motivational music, positively reinforcing sounds and direct messages to patients.

The patients who watched the nature video had a 13 percent drop in their pain scores, while patients who watched the virtual reality game had a 24 percent decline in their pain levels. The VR group had no change in their blood pressure or heart rate.

“We found that use of a 15-minute VR intervention in a diverse group of hospitalized patients resulted in statistically significant and clinically relevant improvements in pain versus a control distraction video without triggering adverse events or altering vital signs,” wrote lead author Brennan Spiegel, MD, director of Cedars-Sinai’s Health Service Research.

“These results indicate that VR may be an effective adjunctive therapy to complement traditional pain management protocols in hospitalized patients.”

scenes from virtual reality game

scenes from virtual reality game

Researchers say it’s unknown exactly how VR works to reduce pain levels, but one explanation is simple distraction.

“When the mind is deeply engaged in an immersive experience, it becomes difficult, if not impossible, to perceive stimuli outside of the field of attention. By ‘hijacking’ the auditory, visual, and proprioception senses, VR is thought to create an immersive distraction that restricts the mind from processing pain,” said Spiegel.

Because the VR therapy was only 15 minutes long, Spiegel says lengthening the period of pain reduction might require sustained and repeated exposure to a variety of virtual reality content.

Another small study of VR therapy, published in PLOS, found that just five minutes of exposure to a virtual reality application reduced chronic pain by an average of 33 percent.

VR therapy is not for everyone. It may induce dizziness, vomiting, nausea or epileptic seizures, so patients have to be screened and monitored for side effects. Another barrier is age related. Two-thirds of the people who were eligible for the Cedars-Sinai study were unwilling to try VR therapy, particularly older individuals.  

A larger study is underway at the hospital to measure the impact of VR therapy on the use of pain medications, length of hospital stay and post-discharge satisfaction scores.

The Pain RelieVR game was created by AppliedVR , a Los Angeles based company that is developing a variety of virtual reality content to help treat pain, depression and anxiety. Below is a promotional video released by the company.