Author Response: Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder
Teresa C.Frohman, Author, Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman, Stanford University School
Steven L.Galetta, MD, Author, Departments of Neurology and Ophthalmology, New York University Grossman School of Medicine, New York, NY
RobertLisak, MD, Author, Department of Neurology, Wayne State University, Detroit MI
Laura J.Balcer, MD, MSCE, Author, Departments of Neurology, Population Health, and Ophthalmology, New York University Grossman School of Medicine, New York, NY
Michael K.Racke, MD, Author, Quest Diagnostics, 500 Plaza Drive, Secaucus, NJ
LawrenceSteinman, MD, Author, Department of Neurology, Stanford University School of Medicine, Palo Alto, CA
Scott S.Zamvil, Author, Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, California
Elliot M.Frohman, Author, Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman, Stanford University School
Submitted December 02, 2022
Several factors argue against our patient’s semiology representing either a single disorder, or an overlap condition, including the long latency between two distinctive disorders, the highly characteristic features of MS in early life, only to be afflicted with a new and confirmed disorder many years later. The patient did well for many years. An overlap diagnosis of MS could have placed our patient in harm’s way; recognizing now that the treatments are/can be considerably different for MS and NMOSD. Ultimately, the pathobiology of MS and NMOSD are considerably different.
Occam is the principle that the simplest explanation is typically the correct one.1 Alternatively, “patients can have as many diagnoses as they please.”; Hickam’s dictum. “Crabtree’s bludgeon,” reflects the powerful tendency to make data consistent with, or to entirely fit, within the framework of a hypothesis formulated by those who hold such to reflect truth.
Diagnostic verification must include the exploration of validity, the construct of so-called Bayesian probability, the basis of which rests upon knowledge, experience, testing, and future observations.
Patients deserve to have their working diagnoses challenged when new data emerges that suggests a different disorder, especially one with a potentially different treatment intervention.
Several factors argue against our patient’s semiology representing either a single disorder, or an overlap condition, including the long latency between two distinctive disorders, the highly characteristic features of MS in early life, only to be afflicted with a new and confirmed disorder many years later. The patient did well for many years. An overlap diagnosis of MS could have placed our patient in harm’s way; recognizing now that the treatments are/can be considerably different for MS and NMOSD. Ultimately, the pathobiology of MS and NMOSD are considerably different.
Occam is the principle that the simplest explanation is typically the correct one.1 Alternatively, “patients can have as many diagnoses as they please.”; Hickam’s dictum. “Crabtree’s bludgeon,” reflects the powerful tendency to make data consistent with, or to entirely fit, within the framework of a hypothesis formulated by those who hold such to reflect truth.
Diagnostic verification must include the exploration of validity, the construct of so-called Bayesian probability, the basis of which rests upon knowledge, experience, testing, and future observations.
Patients deserve to have their working diagnoses challenged when new data emerges that suggests a different disorder, especially one with a potentially different treatment intervention.