Revision of Multiple Sclerosis Cases According to New 2017 McDonald Criteria Among Diagnosed Patients in Sulaimani City

Background Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory disorder of the central nervous system. The diagnosis of Multiple sclerosis is challenging, owing to having a comprehensive list of differentials and mimickers. Objectives To determine the frequency of misdiagnosed Multiple Sclerosis cases diagnosed among those patients in Sulaimani city. Patients and and Methods This retrospective observational study was conducted within a period between December 24th. 2019 and June 10th, 2020, on 106 already diagnosed patients. The study included patients diagnosed with the relapse-remitting form of multiple sclerosis. We excluded those patients with progressive forms of multiple sclerosis. We re-evaluated each patient in-depth and stratified the cases according to the diagnosis certainty based on the fulfillment of the 2017 McDonald Criteria. Finally, we returned those suspicious cases to the multiple sclerosis committee of Shar hospital to verify their final diagnosis. Results Sixteen (16.9%) out of 106 patients, there was diagnostic uncertainty in which 6 (5.7%) of them received the confirmatory diagnosis of relapse-remitting multiple sclerosis by the committee, and 1(0.9%) patient considered secondary progressive multiple sclerosis. In the remaining 9 (8.4%) patients, we found the clinically isolated syndrome in 5 (4.7%) patients, solitary sclerosis in 1 (0.9%) patient, stroke with polycythemia rubra vera (PRV) in 1 (0.9%) patient, possible cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in 1 (0.9%) patient, and 1 (0.9 %) patient was undiagnosed. Conclusion To sum up, the frequency of multiple sclerosis misdiagnosis was 8.4% in Sulaimani city, slightly lower than the other reporting centers.