Despite Early Signs of Multiple Sclerosis, Diagnosis Often Occurs Years Later


Before first diagnosis, patients with multiple sclerosis had more frequent encounters with medical doctors of different specialties compared to matched controls.

Using ambulatory claims data, researchers explored the occurrence of diseases and symptoms in the 5 years prior to diagnosis in patients with multiple sclerosis (MS) and found that diagnosis often occurs not at their first demyelinating event, but years later.

Lead author Christiane Gasperi, MD, Department of Neurology, University of Munich, and colleagues also concluded that “symptoms and physician encounters before MS diagnosis seem to be related to already ongoing disease rather than a prodrome.” The investigators compared these occurrences in patients with MS (n = 10,262) to patients with 2 other autoimmune diseases, Chron’s disease (n = 15,502) and psoriasis (n = 98,432), as well as individuals without these diseases (n = 73,430).

A total of 43 ICD-10 codes were significantly more frequently recorded for patients with MS than for patients with any of the considered autoimmune diseases in the 5 years prior to first diagnosis. Neurological or cerebrovascular disorders or symptoms linked to neurological diseases represented 14 of the identified codes.

Patients with MS also more frequently recorded ICD-10 codes related to visual disturbance, disc disorders, dizziness or giddiness, motor impairment, disorders of the urinary system, and abnormal skin sensation. Additionally, 6 psychiatric ICD-10 codes that included depressive and persistent mood disorders, dissociative disorder, and nicotine dependence were associated with higher odds ratios (ORs) of MS diagnosis.

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In the sensitivity analysis that excluded patients with symptoms suggestive of demyelinating events or neurological symptoms prior to the first diagnosis, the results of the ORs of MS were below 1.0 for 11 of the 20 ICD-10 codes that could still be analyzed. Notably, none of the 20 ICD-10 codes analyzed in this analysis were significantly and positively associated with MS diagnosis after correlation for multiple testing.

Gasperi and colleagues also identified 7 ICD-10 codes that were less frequently recorded in patients with MS than in patients without any of the autoimmune diseases. Four of these were for infections of the upper respiratory tract, Conjunctivitis (H10), Gastritis and duodenitis (K29), and Abdominal and pelvic pain (R10).

Prior to first diagnosis, patients with MS had more frequent encounters with medical doctors of different specialties, especially for neurologists and neurosurgeons, compared to matched controls without any of the 3 autoimmune diseases. Other medical specialists more frequently seen by patients with MS included urologists, specialists for physical and rehabilitative medicine, radiologists, nuclear medicine doctors, ophthalmologists, orthopedists, surgeons, psychiatrists and psychotherapists, as well as ear-nose-throat specialists.

The authors noted another interesting finding that age was related to a few of the spectrum of ICD-10 codes recorded. ORs for Abnormalities of gait and mobility (R26) and Dizziness and giddiness (R42) were more pronounced in older while Disturbances of skin sensation (R20) or Visual disturbances (H53) were more pronounced in younger people.

"Many of the ICD-10 codes recorded more frequently for patients with MS and possibly related to not recognized demyelinating events were not recorded by neurologists, but by general practitioners of other medical specialists; suggesting that timely consultation of neurologists might facilitate earlier diagnosis at least for some of the patients,” Gasperi et al wrote.

Gasperi C, Hapfelmeier A, Daltrozzo T, et al. Systematic assessment of medical diagnoses preceding the first diagnosis of multiple sclerosis. Neurology. Published April 26, 2021. doi: 10.1212/WNL.0000000000012074
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