Neurological

Study reveals major challenges in the early diagnosis of MS

The early detection of multiple sclerosis (MS) remains a major challenge. The results of a study recently published in Neurology suggested that missed demyelinating events that occur years before diagnosis may better identify the disease earlier in the course, while early symptoms seemingly related to MS are actually in the course of an ongoing illness Can be compared to a prodrome.

“Prodrome” is a set of symptoms that suggest a disease before any diagnostic signs and symptoms appear. Recent studies suggest that there may be a prodromal phase in MS, particularly suggesting the increased prevalence of symptoms, diagnoses, and health care utilization in patients several years prior to being diagnosed with MS. Symptoms that often appear before a MS is diagnosed include fatigue, depression and / or anxiety, headache, pain, insomnia, and gastrointestinal disorders.

In the current study, researchers looked at the early prevalence of these diseases and symptoms up to 5 years before MS was diagnosed in patients who were listed in a German administrative database. The study included MS cases that occurred between 2010 and 2017.

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The study investigators identified 10,262 patients with MS and compared those cases to 113,984 patients with autoimmune disease and 73,430 patients without autoimmune disease. They identified 43 ICD-10 codes that were more commonly reported in patients with MS prior to diagnosis, with most of these codes suggesting or indicating neurological disorders or symptoms.

In a repeated analysis that excluded patients with ICD-10 code-associated symptoms that indicated recurrence of MS 5 years prior to diagnosis, it was found that none of the remaining ICD-10 codes were significantly associated with MS. There was an inverse relationship between MS and codes for upper respiratory infections.

Given that this research was based on administrative health data, the study may be limited by its inability to determine whether the neurological diagnoses and symptoms were in fact MS, demyelinating events, or other neurological diagnoses.

The editorial authors suggested that “Advances in removing barriers to early MS diagnosis require efforts to improve the quality of health systems and neurology providers and in collaboration with ours” [non-neurologist] Colleagues.”

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.

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Solomon AJ, Ascherio A. Early Diagnosis of Multiple Sclerosis: Additional Evidence for Missed Opportunities. Neurology. Published online June 15, 2021. doi: 10.1212 / WNL.0000000000012087

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