Factors Associated With Speed of Multiple Sclerosis Diagnosis

While there have been significant reductions in the time it takes to diagnose multiple sclerosis (MS) after the onset of symptoms, delays still occur and their causes are not always clear. With mounting evidence¹ that early treatment can decrease the risk of progression and prevent disability, identifying the causes of delayed diagnosis is more important than ever.

In a new study published in Multiple Sclerosis Journal, the authors modeled the time from first contact to first consultation and from evaluation to diagnosis.² They analyzed 522 individuals who live or receive care in Switzerland using the Swiss Multiple Sclerosis Registry, which is an ongoing Swiss-based, patient-centered, longitudinal observational study.

The authors sought to analyze setting- and patient-specific features that may delay diagnosis throughout the diagnostic process.

“This knowledge could lead to an optimization of the diagnostic process and possibly to an earlier start of drug and non-drug (eg, neurorehabilitation, lifestyle adjustments) treatment of MS patients,” the authors explained.

The participants were mostly female with relapsing/remitting MS (74%) and an Expanded Disability Status Scale score below 4 (81%). Primarily, patients contacted general practitioners first, and they usually referred the patient to a neurologist who led the diagnostic tests and made a diagnosis. Going through this process did not prolong the diagnostic process compared with patients who went directly to a neurologist. Instead, the authors found that type of MS or first symptoms were more closely associated with whether or not the process was prolonged.

The researchers found that primary progressive MS (PPMS), gait problems at onset, and living in a mountainous region were associated with a longer contact-to-evaluation time, whereas diagnosis after 2000, having a school leaving certificate, and dysarthria at onset were associated with a shorter time.

Prolonged delays from evaluation to diagnosis occurred when depression was observed as a concomitant first symptom, when there was lack of action by a nonneurologist, and with PPMS. There were shorter times when diagnosis occurred after 2010, the neurologist led the tests, or the first visit occurred at a hospital.

“For a faster diagnostic process, awareness for MS as a differential diagnosis of gait disorders should be raised, and an attentive follow-up of possible MS cases with depression as a concomitant first symptom is needed,” the authors concluded.

References

1. Brown JWL, Coles A, Horakova D, et al. Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

2. Barin L, Kamm CP, Salmen A, et al. How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? the influence of setting and physician specialty on speed of diagnosis [published online January 18, 2019]. Mult Scler. doi: 10.1177/1352458518823955.