Delayed diagnosis of multiple sclerosis in a low prevalence country

ABSTRACT

Background: Early diagnosis and treatment of multiple sclerosis (MS) is crucial to avoid future disability. The factors that influence diagnostic delay in low prevalence settings have been poorly studied.

Objectives: To evaluate the factors associated with a delayed diagnosis of MS after the symptomatic onset.

Methods: Clinical records of confirmed MS patients were reviewed. Diagnostic delay was calculated by subtracting the date of onset from the date of diagnosis and categorized as early and delayed, when below and above than 1 year. Logistic regression was performed to evaluate the likelihood of a delayed diagnosis according to age at first symptom, gender, type of the first symptom, progressive vs relapsing onset, diagnostic criteria prevailing at the time of symptom onset, comorbidities, and family history of MS.

Results: Data of 525 (95.6%) from a cohort of 549 patients were analyzed. About 69.1% were women. The mean age was 43.2 years. About 86.3% had relapsing-remitting MS. The mean overall diagnostic delay was 3.07 years. About 45.7% of the patients had a delayed diagnosis, and it was dependent on the symptom and the diagnostic criteria prevailing at the onset. Multivariate logistic regression showed onset during the Schumacher (OR = 10.03 [95%CI 1.30–77.1], p = 0.027) and Poser (OR = 4.26 [95%CI 1.25–15.15], p = 0.021) years were associated with delayed MS diagnosis.

Conclusions: MS onset before the McDonald diagnostic criteria era is associated with delayed diagnosis.

KEYWORDS:

• Multiple sclerosis
• diagnosis
• delayed diagnosis
• observational study
• diagnostic delay

Acknowledgments

The authors are grateful with Mar Tintoré, MD, PhD, Rodrigo Pardo MD, MSc, Pere Carbonell-Mirabent, Saúl Reyes, MD and Jaime Toro, MD for their observations on the manuscript writing. We thank Andrea del Pilar Calderón MD, Hernan Acosta MD, Mateo Enciso MD, David Ríos MD, Andrés Morcillo MD, Ángela Muñoz MD, Pilar Enriquez MD, Rubén Arenas MD, Edwin Páez MD, and Steven Hurtado MD for their support with the data gathering and management.

Disclosure statement

S.C.-R. is an ECTRIMS clinical fellowship awardee and reports consulting fees from Novartis, Biogen-Idec and Roche, and travel expenses for scientific meetings from Sanofi-Genzyme, Abbott and Tecnofarma. L.L.-R. has nothing to disclose. L.A-V reports travel expenses for scientific meetings from Roche and Tecnofarma. M.C-P. has nothing to disclose. C.G.-S. reports consulting fees from Novartis, Biogen-Idec, and travel expenses for scientific meetings from Sanofi-Genzyme. None of the above is related to the present study.

Data availability statement

All data are available upon request, with previous authorization from the ethics committee.

Ethics approval

This study was approved by the ethics committee of the National University Hospital of Colombia.

Geolocation information

MS Center, National University Hospital of Colombia, Calle 44 # 59-75, 111321, Bogotá, Colombia .

Author contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by LLR and LEAV. Analysis was performed by SCR, LLR, and MCP. The first draft of the manuscript was written by SCR and all authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Additional information

Funding

This research did not receive any particular funding.