![]() In managing a sensory relapse in a patient already on disease modifying therapy (DMT), 92% of MS experts said that they would recommend switching therapy compared with 66% of general neurologists (P <. For instance, when presented with a newly diagnosed young female with moderate risk factors, 51% of experts prioritized high-efficacy injectable/infusion therapy including natalizumab, ocrelizumab, or ofatumumab vs 32% of general neurologists (P <. However, the two groups varied in how the factors influenced their therapeutic decision-making in clinical scenarios. Most general neurologists and MS experts were able to identify negative prognostic factors in MS, such as spinal lesions. When presented with a case, 63% of general neurologists misapplied dissemination in time (DIT) criteria compared with just 8% of MS experts (P <. Specifically, only 4% of general neurologists identified juxtacortical lesions vs 58% of MS experts, whereas 28% vs 88% identified periventricular lesions (both, P <. In addition, only 14% of general neurologists identified the correct definition of both juxtacortical and periventricular lesions. Up to 70% of general neurologists incorrectly identified MRI optic nerve as being part of MS MRI dissemination in space (DIS) criteria 61% incorrectly selected deep white-matter lesions as belonging in DIS criteria. ![]() For example, 54% incorrectly identified bilateral optic neuritis as a typical presentation vs 19% of the experts (P <. Among the respondents, the general neurologists scored well in classifying common presentations that are typical for MS but misclassified various syndromes. Questions on the survey were selected to assess clinicians' understanding and application of the McDonald Diagnostic criteria for MS, as well as clinical decision-making strategies. It included 26 MS experts from diverse academic centers in the United States and Canada and 100 randomly selected US-based neurologists who reported managing three to 15 patients with MS per week. To further evaluate levels of knowledge of key MS diagnostic and management practices, the current investigators conducted an online survey in August 2021. Detrimental Implications? Amid evidence of notable differences in therapeutic decision-making patterns between MS specialists and neurology nonspecialists, some evidence has emerged suggesting the differences could reflect knowledge gaps in standard practices, with potentially detrimental implications. The findings were presented at the Consortium of Multiple Sclerosis Centers (CMSC) 2022 Annual Meeting. Overall, the results underscore that "educational efforts are needed to ensure proper understanding and application of the MS diagnostic criteria," Solomon said. Solomon, MD, associate professor of neurological sciences and division chief of MS at Larner College of Medicine, The University of Vermont, Burlington, told Medscape Medical News. "The high rate of knowledge deficiencies and application errors of core elements of the McDonald Diagnostic criteria demonstrated by participants in this study raise pressing questions concerning adequacy of dissemination and educational efforts upon publication of revisions" to the criteria, co-investigator Andrew J. NATIONAL HARBOR, MD - As multiple sclerosis (MS) therapies expand and therapeutic decision-making becomes more complex, new research shows that general neurologists fall far below MS specialists in grasping basic diagnostic standards that are critical to optimal patient management. General Neurologists' MS Knowledge Falls Short
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