Diagnostic delay of multiple sclerosis: prevalence, determinants and consequences

被引:14
|
作者
Uher, Tomas [1 ,2 ,3 ,4 ,5 ,6 ]
Adzima, Adrian [4 ,5 ,6 ]
Srpova, Barbora [4 ,5 ,6 ]
Noskova, Libuse [6 ,7 ]
Marechal, Benedicte [8 ,9 ,10 ,11 ]
Maceski, Aleksandra Maleska [12 ,13 ]
Krasensky, Jan [14 ,15 ]
Stastna, Dominika [4 ,5 ]
Andelova, Michaela [4 ,5 ]
Novotna, Klara [4 ,5 ]
Vodehnalova, Karolina [4 ,5 ]
Motyl, Jiri [4 ,5 ]
Friedova, Lucie [4 ,5 ]
Lindner, Jiri [14 ,15 ]
Ravano, Veronica [8 ,9 ,10 ,11 ]
Burgetova, Andrea [14 ,15 ]
Dusek, Petr [4 ,5 ,6 ,14 ,15 ]
Fialova, Lenka [6 ,7 ]
Havrdova, Eva Kubala [4 ,5 ,6 ]
Horakova, Dana [4 ,5 ,6 ]
Kober, Tobias [8 ,9 ,10 ,11 ]
Kuhle, Jens [16 ,17 ,18 ,19 ,20 ,21 ]
Vaneckova, Manuela [14 ,15 ]
机构
[1] Charles Univ Prague, Fac Med 1, Dept Neurol, Katerinska 30, Prague 12000, Czech Republic
[2] Charles Univ Prague, Fac Med 1, Ctr Clin Neurosci, Katerinska 30, Prague 12000, Czech Republic
[3] Charles Univ Prague, Gen Univ Hosp, Katerinska 30, Prague 12000, Czech Republic
[4] Charles Univ Prague, Fac Med 1, Dept Neurol, Prague, Czech Republic
[5] Charles Univ Prague, Fac Med 1, Ctr Clin Neurosci, Prague, Czech Republic
[6] Charles Univ Prague, Gen Univ Hosp, Prague, Czech Republic
[7] Charles Univ Prague, Inst Med Biochem & Lab Diagnost, Fac Med 1, Prague, Czech Republic
[8] Siemens Healthineers Int AG, Adv Clin Imaging Technol, Lausanne, Switzerland
[9] Lausanne Univ Hosp, Dept Radiol, Lausanne, Switzerland
[10] Univ Lausanne, Lausanne, Switzerland
[11] Ecole Polytech Fed Lausanne EPFL, Signal Proc Lab LTS5, Lausanne, Switzerland
[12] Univ Basel, Univ Hosp Basel, Dept Med, Neurol Clin & Policlin, Basel, Switzerland
[13] Univ Basel, Univ Hosp Basel, Dept Biomed & Clin Res, Neurol Clin & Policlin, Basel, Switzerland
[14] Charles Univ Prague, Fac Med 1, Dept Radiol, Prague, Czech Republic
[15] Gen Univ Hosp Prague, Prague, Czech Republic
[16] Univ Hosp, Multiple Sclerosis Ctr, Dept Biomed, Basel, Switzerland
[17] Univ Hosp, Multiple Sclerosis Ctr, Dept Clin Res, Basel, Switzerland
[18] Univ Hosp, Res Ctr Clin Neuroimmunol & Neurosci RC2NB, Dept Biomed, Basel, Switzerland
[19] Univ Hosp, Res Ctr Clin Neuroimmunol & Neurosci RC2NB, Dept Clin Res, Basel, Switzerland
[20] Univ Basel, Basel, Switzerland
[21] Univ Hosp, Dept Neurol, Basel, Switzerland
关键词
Delayed diagnosis; misdiagnosis; brain lesion; magnetic resonance imaging; neurofilament; cerebrospinal fluid; disability; multiple sclerosis; COMORBIDITY;
D O I
10.1177/13524585231197076
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Early diagnosis and treatment of patients with multiple sclerosis (MS) are associated with better outcomes; however, diagnostic delays remain a major problem.Objective: Describe the prevalence, determinants and consequences of delayed diagnoses.Methods: This single-centre ambispective study analysed 146 adult relapsing-remitting MS patients (2016-2021) for frequency and determinants of diagnostic delays and their associations with clinical, cognitive, imaging and biochemical measures.Results: Diagnostic delays were identified in 77 patients (52.7%), including 42 (28.7%) physician-dependent cases and 35 (24.0%) patient-dependent cases. Diagnosis was delayed in 22 (15.1%) patients because of misdiagnosis by a neurologist. A longer diagnostic delay was associated with trends towards greater Expanded Disability Status Scale (EDSS) scores (B = 0.03; p = 0.034) and greater z-score of the blood neurofilament light chain (B = 0.35; p = 0.031) at the time of diagnosis. Compared with patients diagnosed at their first clinical relapse, patients with a history of >1 relapse at diagnosis (n = 63; 43.2%) had a trend towards greater EDSS scores (B = 0.06; p = 0.006) and number of total (B = 0.13; p = 0.040) and periventricular (B = 0.06; p = 0.039) brain lesions.Conclusion: Diagnostic delays in MS are common, often determined by early misdiagnosis and associated with greater disease burden.
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页码:1437 / 1451
页数:15
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