Objective: Analyze diagnostic errors in a Movement Disorder Section (MDS) in a public hospital in Buenos Aires, Argentina.

Background: Abnormal movements are a common complaint in clinical practice.. Clinicians must rely on interpreting a combination of clinical features, symmetry, onset, response to treatment. The diagnostic process is subjective, therefore liable to error. Some patients remain misdiagnosed for long periods without receiving specific treatment.

Methods: We review all medical records of patients evaluated in our MDS from 2010 to 2015. Patients with less than one-year follow-up were excluded. We analyzed: sex, age, prior diagnosis made in other centers, our initial and final diagnosis, and if the initial diagnosis was modified. For statistical significance, IBM SPSS statistics 20, was used.

Results: We included 606 medical records. Fifty one percent were woman, media age: 59 yo. Fifty four percent (330p) had already been assisted in another center and came with a prior diagnosis: 64% were Idiopathic Parkinson’s disease (PD), 9 % Dystonia, 6% Essential Tremor (ET), 6% Facial Spasm (FS), 3% Ataxia, 2% Huntington Disease (HD), 2% Atypical Parkinsonian Disorders (APK), and others 8%. Among the patients seen for the first time (46 %, 276p), our initial diagnosis was; 52% PD, 10% Chorea, 8,5% ET, 8,5% Dystonia, 8% FS, 2% Ataxia, 3% APK and others 8%. The final diagnosis did not change in more than 90% of the patients. In only 10%, the initial diagnosis made in our or in other centers was changed. Among them 90% was refered with a wrong prior diagnosis from a non specialized center. Most frequent pitfalls were: PD for APK (6p); PD for ET (7p) and Psiquiatric disorders for HD (3p). Our initial diagnosis changed in 10%. Our most frequent pitfalls were to diagnose APK for PD (4p), PD for vascular parkinsonism (1p) and PD for APK (1p).

Conclusions: Although the diagnosis process was frequently straightforward, a movement disorders specialist evaluation was required to establish a final diagnosis in certain cases. More time of follow up was required in some other patients in order to clarify the diagnosis. It is likely that, in coming years, new biomarkers or imaging techniques will assist the diagnostic process. Meanwhile, the diagnosis of movement disorders remains clinical and the most important aspects are the careful observation of signs and symptoms, their evolution, the treatment response, and the appearance of atypical clinical features.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/how-do-we-make-mistakes-diagnosing-movement-disorders/