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Clinical utility of the list sign as a predictor of non-demyelinating disorders in a multiple sclerosis (MS) practice

Published online by Cambridge University Press:  03 May 2016

Deepti Anbarasan ,
Gabriel Campion ,
Paul Campion  and
Jonathan Howard
Deepti Anbarasan*
Affiliation:
Departments of Neurology, NYU School of Medicine, New York, New York, USA Departments of Psychiatry, NYU School of Medicine, New York, New York, USA
Gabriel Campion
Affiliation:
NYU School of Medicine, New York, New York, USA
Paul Campion
Affiliation:
Departments of Psychiatry, NYU School of Medicine, New York, New York, USA
Jonathan Howard
Affiliation:
Departments of Neurology, NYU School of Medicine, New York, New York, USA Departments of Psychiatry, NYU School of Medicine, New York, New York, USA NYU Langone Medical Center, Multiple Sclerosis (MS) Comprehensive Care Center, New York, New York, USA
*
*Address for correspondence: Deepti Anbarasan, Departments of Neurology & Psychiatry, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA. (Email: [email protected])
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Abstract

Objectives

Not all patients referred for evaluation of multiple sclerosis (MS) meet criteria required for MS or related entities. Identification of markers to exclude demyelinating disease may help detect patients whose presenting symptoms are inconsistent with MS. In this study, we evaluate whether patients who present a self-prepared list of symptoms during an initial visit are less likely to have demyelinating disease and whether this action, which we term the “list sign,” may help exclude demyelinating disease.

Methods

Using chart review, 300 consecutive new patients who presented for evaluation to a neurologist at a tertiary MS referral center were identified retrospectively. Patients were defined as having demyelinating disease if diagnosed with MS or a related demyelinating condition.

Results

Of the 233 enrolled subjects, 157 were diagnosed with demyelinating disease and 74 did not meet criteria for demyelinating disease. Fifteen (8.4%) subjects had a positive list sign, of which 1 patient had demyelinating disease. The 15 subjects described a mean of 12.07 symptoms, and 8 of these patients met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for somatic symptom disorder. The specificity and positive predictive value of the list sign for non-demyelinating disease were 0.99 (95% confidence interval (CI) 0.96–0.99) and 0.93 (95% CI 0.66–0.99), respectively.

Conclusion

A positive list sign may be useful to exclude demyelinating disease and to guide diagnostic evaluations for other conditions. Patients with a positive list sign also have a high incidence of somatic symptom disorder.

Keywords

Demyelinatingdiagnosislist signmultiple sclerosisneuropsychiatrysomatic symptom disorder
Type
Original Research
Information
CNS Spectrums , Volume 21 , Special Issue 3: Neuropsychiatry , June 2016 , pp. 265 - 270
Copyright
© Cambridge University Press 2016 

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