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

来源：

MULTIPLE SCLEROSIS JOURNAL | 2023年 / 29卷 / 11-12期

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.

引用

页码：1437 / 1451

页数：15