Time between the first symptom, diagnosis and treatment of multiple sclerosis in a brasilian cohort. The impact of early diagnosis.

Multiple Sclerosis (MS) diagnosis can be challenging, especially in populations where the disease is rare. Delayed diagnosis and access to modifying disease drugs (DMD) can have a negative impact on the course of MS.

The main aim of this study was to estimate the mean time between the first relapse, the diagnosis of MS and initiation of treatment in a cohort of Brazilian MS patients. Also to estimate the impact of these variables in the morbidity.

This is an observational study based on clinical records of patients followed in a Neurology Clinic of Hospital Governador Israel Pinheiro (HGIP) in Belo Horizonte, Minas Gerais. 

Data of 61 patients were analyzed. About 73,8% (45) were women. The mean age of the first symptom, diagnosis and DMT initiation was, respectively, 30,93 (+/- 11,94), 32 (25 - 43) and 36,17 (+/- 14,2) years old. About 50,82% (31) of the patients had an early diagnosis within the first year of disease, 26,23% (16) the diagnosis was made through 1-5 years, and 22,95% (14) had a delay of more than five years. Once the diagnosis was made, 50% had access to DMD within 6 months and 77,05% in the first year. Patients with early diagnosis had their first symptom at a younger age, with a median of 27 years compared to 32,5 years old in those with late diagnosis. (p=0.63). In the follow-up, the median EDSS was 2.5 in the late diagnosis, while among patients with early diagnosis, the median EDSS was 1.5 (p<0.05).

MS diagnosis can be challenging especially in developing countries, where the suspicious can be lower and there are fewer widely available resources for the investigation. It is important to achieve a correct diagnosis in these poorly studied populations. Especially because patients with delayed diagnosis and DMT initiation appears to have more disability.