Think Twice: Benefits of Second Opinions in Neurology

Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. In the past 30 years, the absolute numbers of deaths and the number of people with neurological-related diseases have risen substantially¹.

If you have been referred to a neurologist, it’s because you have demostrated sympoms that point to a disorder of the nervous system.

We tend to assume that neurology only relates to the brain. Yet neurologists diagnose and treat a wide range of neurological conditions that have their origins in the brain or the spinal cord.

They can include quality-of-life conditions, such as migraines, neuropathy (peripheral nerve damage that causes weakness, numbness, and pain in the hands and feet), or sleep apnea.

More serious conditions include strokes, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, ALS, brain timors, or infections of the nervous system including meningitis or encephalitis.

When it comes to neurological assessments, the stakes are significant, making seeking a second opinion not merely a suggestion but often a way to improve one’s peace of mind.

Whether you’ve been diagnosed with a chronic condition like multiple sclerosis or something more acute like a stroke, a second opinion might provide clarity, confirm a diagnosis, and open up new treatment options with potential to impact your quality of life.

The Complexity of Neurology Diagnoses

Neurological conditions are complex largely because the brain and nervous system control every function of the body. Certain symptoms are common among a number of disorders which can make accurate diagnosis challenging. For example, MS, Lyme disease, and certain vitamin deficiencies can present with similar symptoms, like fatigue, numbness, and cognitive changes. Clearly, treatment of a vitamin deficiency is far less complicated than treatment of MS and it’s easy to see why a second opinion may give you a fresh look at your symptoms, test results, diagnosis, and potential treatment.

Parkinson’s Disease: Neurological Missteps

A good example of complex neurological diagnosis is the testing for Parkinson’s disease.

We all know that the most common and outwardly viewable symptoms of Parkinson’s are tremors, instability or other motor malfunctioning (e.g., frequent falling). These very symptoms can lead to a different diagnosis, for example, drug induced tremors or certain kinds of palsy of other atrophy that can explain those symptoms.

The error rate of a clinical diagnosis of Parkinson’s is high. A meta-analysis reported that the error rate was 26.2% by nonexperts, and from 16.1% (for initial diagnosis) to 20.4% (for follow up diagnosis) by experts².

The high error rate in PD diagnosis may be because clinical diagnoses are mainly based on results of clinical tests and response to antiparkinsonian medication. Imaging is only used as an assistance in PD diagnosis³.

Another challenge in the diagnosis of Parkinson’s is early detection because at early stages of the disease, brain changes and symptoms are subtle. The period between the onset of neurodegeneration and the emergence of motor symptoms might last from several years to decades⁴.

Early treatment can slow down progression and potentially prevent more severe symptoms from developing. Progressive brain atrophy has been detected on structural MRIs, even at early Parkinson’s stages⁵ and analysis of your imaging is crucial. For these reasons, a neurological second opinion may give you peace of mind, and perhaps the ability to detect Parkinson’s at early stages so that treatment can be effective.

Stroke of Misfortune

According to the Stroke Awareness Foundation, about 795,000 people in the United Staes suffer a stroke each year. Someone has a stroke every 40 seconds, and every 4 minutes someone dies from stroke. Yet 80% of strokes are preventable⁶.

We all know that stroke is essentially blood blockage. Supply to the brain is blocked by a clot or a tear. The most common type of strokes are ischemic, caused by a blood clot that deprives the brain of oxygen.

Time is of the essence when it comes to strokes. In one second, 32,000 brain cells die, and in 59 seconds an ischemic stroke will have killed 1.9 million brain cells⁷.

Data has shown that 20% of large vessel occlusions, a type of ischemic stroke, were missed at an initial CT evaluation. Those who were not neuroradiologists were more likely to miss large-vessel occlusion compared with neuroradiologists and several factors may have an association with missing a large-vessel occlusion on CT, including the CTA interpreter, the location of the large-vessel occlusion, and whether the large-vessel occlusion was caused by calcified emboli⁸.

Awareness of these factors may improve the accuracy in interpreting CT and eventually improve stroke outcome. Recognizing the symptoms and the imaging is crucial for treatment and ultimately for long term recovery.

And for these reasons alone, a neurological second opinion that may be secured in a short period of time has the potential reduce the extent of brain damage, severe disability or even death.

Epilepsy: Neurology Diagnosis

Around about 2.9 million adults in the United States alone reported having active epilepsy.

That is about 1% of all U.S. adults. Additionally, 456,000 U.S. children 17 and younger have active epilepsy⁹. In total, there are more than 50 million worldwide diagnosed with this disease¹⁰.

In essence, epilepsy is a disruption to electrical activity in the brain which can lead to seizures and cause movement, behaviour, and level of awareness changes in those suffering from the disease.

The challenge in diagnosing epilepsy is that not everyone who has a seizure necessarily has epilepsy. In recent MRI studies of functional seizure patients, 23% demonstrated epilepsy risk factors, 8% showed borderline epilepsy associated factors, and 10% definitive epilepsy associated factors¹¹.

Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. Often, medical attention is only sought after presenting with a seizure. Diagnostic delay can be caused by under-reporting by patients or and lack of time in the emergency setting¹². For these reasons, a second opinion of MRI or other related imaging can be helpful in the diagnosis while also may bring you peace of mind.

A Second Opinion: Your First Priority

The vast array of diseases that require neurological evaluation, from the most serious to the most commonly occurring, often require complex imaging studies, such as MRIs, CTs, EEG (Electroencephalogram), functional MRIs, and/or pharmacogenetic tests. Getting a second opinion that may give you a peace of mind is your first priority.

Contact us today to secure a second opinion for your diagnosis and treament.