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

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY Multiple sclerosis and related disorders Pub Date : 2024-11-19 DOI:10.1016/j.msard.2024.106178

Jéssica Resende Vaz de Melo , Lucas Alexandre Santos Marzano , Rodrigo Kleinpaul , Juliana Santiago-Amaral

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Abstract

Introduction

Multiple Sclerosis (MS) diagnosis can be challenging, especially in populations where the disease is rare. In Brazil, the average prevalence is 14/100,000 inhabitants, lower than the worldwide. Early treatment initiation can markedly reduce disease activity and accumulation of disability. Therefore, delayed diagnosis and access to disease modifying therapy (DMT) can have a negative impact on the course of MS.

Objectives

The 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.

Material and method

We retrospectively analyzed the medical records of MS patients who met the 2017 McDonald diagnostic criteria followed in a MS reference center in Belo Horizonte, Minas Gerais. We assessed demographic and clinical data with focus on time to first symptom, time to diagnosis and treatment begging. The last Expanded Disability Status Scale (EDSS) was collected to access disability.

The program GraphPad Prism 8.4.3. was used for the statistical analysis.

Results

Data of 66 patients were analyzed, 77 % (51) were women. The mean age of the first symptom, diagnosis and DMT initiation was, respectively, 30,06 (± 12,43), 35,2 (± 13,59) and 36,10 (± 13,89) years. In 32 (46,38 %) patients the diagnosis was early (<1 year of disease), in 18 (26,09 %) between 1 and 5 years and in 19 (27,54 %) after to five years. Once the diagnosis was established, 65,5 % had access to DMT within 6 months and 79,71 % in the first year.

Patients with diagnosis in the two first years had their first symptom at a younger age (p < 0.05). Comparing these two groups, patients with an earlier diagnosis presented less disability (EDSS: 3,5 vs 1,5; p < 0.05).

Conclusion

MS diagnosis can be challenging especially in low prevalence population of diseased and developing countries. Our study demonstrated the importance of early recognition of MS and its precocious intervention, impacting in reducing of disability a long term

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巴西队列中多发性硬化症的首次症状、诊断和治疗之间的时间早期诊断的影响

多发性硬化症（MS）的诊断可能具有挑战性，特别是在疾病罕见的人群中。在巴西，平均患病率为14/10万居民，低于世界范围。早期治疗可以显著减少疾病活动和残疾的积累。因此，延迟诊断和获得疾病修饰治疗（DMT）可能对MS病程产生负面影响。目的：本研究的目的是估计巴西MS患者首次复发，MS诊断和开始治疗之间的平均时间。材料与方法我们回顾性分析了在米纳斯吉拉斯州贝洛奥里藏特的MS参考中心随访的符合2017年麦当劳诊断标准的MS患者的病历。我们评估了人口统计学和临床数据，重点是首次出现症状的时间、诊断时间和治疗时间。收集最新的扩展残疾状态量表（EDSS）来访问残疾。程序GraphPad Prism 8.4.3。进行统计分析。结果分析66例患者资料，其中女性51例，占77%。首次出现症状、确诊和开始DMT的平均年龄分别为30、06（±12、43）岁、35、2（±13、59）岁和36、10（±13、89）岁。32例（46,38 %）患者诊断早期（发病1年），18例（26,09%）在1 - 5年之间，19例（27,54 %）在5年之后。一旦确诊，65.5%的人在6个月内接受了DMT治疗，79.71%的人在第一年接受了DMT治疗。在头两年确诊的患者在较年轻的年龄出现首次症状(p <；0.05)。比较这两组，早期诊断的患者出现的残疾较少(EDSS: 3,5 vs 1,5；p & lt;0.05)。结论多发性硬化症的诊断具有挑战性，特别是在低患病率人群和发展中国家。我们的研究表明，早期认识多发性硬化症及其早期干预的重要性，对减少残疾的长期影响

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.