įND may also present as a comorbid condition in patients with an accurate diagnosis of MS, in which case both conditions warrant treatment. Misdiagnosis can also cause psychological harm in patients if they partially shape their identity around a diagnosis of MS or FND that they are later informed is incorrect. Patients with FND who are misdiagnosed with MS have a prognosis similar to MS but which may improve with more modern evidence-based treatment. However, DMTs carry unnecessary side-effects and risks for patients with FND who are misdiagnosed with MS. Misdiagnosis of FND in patients who have MS may result in irreversible disability as a consequence of delays in the initiation of disease modifying therapy (DMT). Misdiagnosis of MS or FND causes harm to patients, most generally in the form of a delay to diagnosis and initiation of proper treatment. They also share a similar epidemiology, with a preponderance of female to male patients, and both are common conditions in neurological practice. Multiple sclerosis (MS) and functional neurological disorder (FND) are both diagnostically challenging conditions presenting at times with similarly disabling paroxysmal, fluctuating, and multifocal neurological symptoms.
Misdiagnosis and comorbidity in a landscape of emerging evidence-based treatments for both MS and FND are issues not only of clinical importance to the care of these patients, but also to treatment trials, especially of MS, where FND could be a hidden confounder. Comorbidity between these two conditions is also likely common, has been poorly studied, and adds complexity to diagnosis and treatment in patients with both MS and FND.
We discuss the clinical errors that appear to result in misdiagnoses, such as over-reliance on psychiatric comorbidity when making a diagnosis of FND or over-reliance on neuroimaging for the diagnosis of MS, and practical ways to avoid them. Our review suggests that MS is one of the most common causes of misdiagnosis of FND and vice versa. In addition to FND, we included studies of patients with other functional and psychiatric disorders where these caused symptoms leading to investigation for or a diagnosis of MS, which in a different context would likely have been labeled as FND. We systematically reviewed the literature to identify patients with MS who were misdiagnosed with FND, patients with FND who were misdiagnosed with MS, and reports of patients with both conditions. Multiple sclerosis (MS) and functional neurological disorder (FND) are both diagnostically challenging conditions which can present with similar symptoms.
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