Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-04T17:55:04.925Z Has data issue: false hasContentIssue false
  • English
  • Français

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])
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McDonald, WI, Compston, A, Edan, G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the Diagnosis of Multiple Sclerosis. Ann Neurol. 2001; 50(1): 121–127.CrossRefGoogle ScholarPubMed
2. Polman, C, Reingold, SC, Edan, G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria”. Ann Neurol. 2005; 58(6): 840–846.CrossRefGoogle Scholar
3. Miller, D, Weinshenker, B, Filippi, M, et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler. 2008; 14(9): 1157–1174.CrossRefGoogle ScholarPubMed
4. Carmosino, MJ, Brousseau, KM, Arciniegas, DB, Corby, JR. Initial evaluations for multiple sclerosis in a university multiple sclerosis center: outcomes and role of magnetic resonance imaging in referral. Arch Neurol. 2005; 62(4): 585–590.CrossRefGoogle Scholar
5. Kelly, SB, Chaila, E, Kinsella, K, et al. Using atypical symptoms and red flags to identify non-demyelinating disease. J Neurol Neurosurg Psychiatry. 2012; 83(1): 44–48.CrossRefGoogle ScholarPubMed
6. Burneo, JG, Martin, R, Powell, T, et al. Teddy bears: an observational finding in patients with non-epileptic events. Neurology. 2003; 61(5): 714–715.CrossRefGoogle ScholarPubMed
7. Bengtzen, R, Woodward, M, Lynn, MJ, Newman, NJ, Biousse, V. The “sunglasses sign” predicts nonorganic visual loss in neuro-ophthalmologic practice. Neurology. 2008; 70(3): 218–221.CrossRefGoogle Scholar
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.Google Scholar
9. Sharpe, M. Somatic symptoms: beyond ‘medically unexplained’. Br J Psychiatry. 2013; 203(5): 320–321.CrossRefGoogle ScholarPubMed
10. Smith, RC. A clinical approach to the somatizing patient. J Fam Pract. 1985; 21(4): 294–301.Google Scholar
11. Noyes, R Jr, Holt, CS, Kathol, RG. Somatization. Diagnosis and management. Arch Fam Med. 1995; 4(9): 790–795.CrossRefGoogle ScholarPubMed
12. Croicu, C, Chwastiak, L, Katon, W. Approach to the patient with multiple somatic symptoms. Med Clin North Am. 2014; 98(5): 1079–1095.CrossRefGoogle Scholar
13. Kroenke, K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007; 69(9): 881–888.CrossRefGoogle ScholarPubMed
14. Solomon, AJ, Klein, EP, Bourdette, D. “Undiagnosing” multiple sclerosis: the challenge of misdiagnosis in MS. Neurology. 2012; 78(24): 1986–1991.CrossRefGoogle ScholarPubMed