Multiple sclerosis diagnostic delay and its associated factors in Upper Egyptian patients

Abstract

The earlier the diagnosis of multiple sclerosis (MS), the sooner disease-modifying treatments can be initiated. However, significant delays still occur in developing countries. We aimed to identify factors leading to delayed diagnosis of MS in Upper Egypt. One hundred forty-two patients with remitting relapsing MS (RRMS) were recruited from 3 MS units in Upper Egypt. Detailed demographic and clinical data were collected. Neurological examination and assessment of the Disability Status Scale (EDSS) were performed. The mean age was 33.52 ± 8.96 years with 72.5% of patients were females. The mean time from symptom onset to diagnosis was 18.63 ± 27.87 months and the median was 3 months. Seventy-two patients (50.7%) achieved diagnosis within three months after the first presenting symptom (early diagnosis), while seventy patients (49.3%) had more than three months delay in diagnosis (delayed diagnosis). Patients with a delayed diagnosis frequently presented in the period before 2019 and had a significantly higher rate of initial non-motor presentation, initial non-neurological consultations, prior misdiagnoses, and a higher relapse rate. Another possible factor was delayed MRI acquisition following the initial presentation in sixty-six (46.5%) patients. Multivariable logistic regression analysis demonstrated that earlier presentation, initial non-neurological consultation, and prior misdiagnosis were independent predictors of diagnostic delay. Despite advances in MS management in Egypt, initial non-neurological consultation and previous misdiagnoses are significant factors responsible for delayed diagnosis in Upper Egypt.

Diagnostic delay of multiple sclerosis: prevalence, determinants and consequences

“…Our study’s DD prevalence was comparable to contemporary cohorts, 7 , 13 – 15 , 21 except for a small single study with a slightly shorter delay, 22 but shorter when compared to historical cohorts. 9 , 12 – 14 , 17 , 32 , 20 This finding supports that DDs are decreasing probably because of more sensitive MS diagnostic criteria, 24 increased MRI availability, 5 and heightened awareness of MS among patients and physicians.…”

“…23 Czech Republic citizens have public health insurance and generally good access to comprehensive medical care, minimizing socioeconomic barriers. 5,15 Therefore, only a minimal number of patients experienced DDs because of long waiting times for paraclinical testing of referral to an MS centre.…”

“…The prevalence of DD remains high but has improved 6 – 15 ( Table 1 ). Predisposing factors include healthcare system barriers, 5 , 15 comorbidities, 16 , 17 primary progressive MS, 7 , 9 , 11 , 12 , 18 , 19 and lower education, 7 , 19 but the exact determinants in individual patients are often unclear.…”

“…The prevalence of DD remains high but has improved 6 – 15 ( Table 1 ). Predisposing factors include healthcare system barriers, 5 , 15 comorbidities, 16 , 17 primary progressive MS, 7 , 9 , 11 , 12 , 18 , 19 and lower education, 7 , 19 but the exact determinants in individual patients are often unclear. Furthermore, the relationship between diagnostic and DMT delays, and disease activity is not well described.…”

A multicenter pilot study evaluating simplified central vein assessment for the diagnosis of multiple sclerosis

“…27 Finally, median time from symptom onset to presentation to an MS center in this study was long; this is unfortunately representative of current dynamics given ongoing neurologist shortages (in previous studies, the delay to see an MS-trained neurologist in various countries ranges from 7 months to 3.9 years). [30][31][32][33] We did not place artificial restraints on time from symptom onset to enrollment, to allow the study to reflect real-world CVS utilization.…”