Early signs of MS can often go undiagnosed

By Amy Norton
Health Day reporter

MONDAY June 28, 2021 (HealthDay News) – Early symptoms of multiple sclerosis can often be missed for years before the correct diagnosis is made, suggests a new study.

The researchers found that patients with MS had a higher than average number of medical appointments, with doctors of various specialties, up to five years before their diagnosis.

And for the most part, those visits were for neurological symptoms consistent with MS – indicating missed opportunities for earlier diagnosis, the researchers said.

“We found that many complaints that led to patient visits were consistent with early clinical relapses that were not recognized as such,” said lead investigator Dr Bernhard Hemmer, a researcher neurologist and professor at the Technical University of Munich in Germany.

“Relapse” refers to the flare-ups of symptoms that mark MS – a neurological disease caused by poor immune system attacks on the body’s own nerve tissue.

Most often, MS follows a relapsing-remitting course, where symptoms flare up for a while and then subside, according to the National MS Society. Because the central nervous system is affected, these symptoms can be far-reaching. Vision problems, muscle weakness, numbness, and difficulty with balance and coordination are among the most common.

In recent years, there has been a debate among scholars as to whether MS has a “prodromal” phase – a time when people experience a variety of non-specific symptoms before the typical features of MS begin.

Hemmer said the new findings suggest something else: At least in the five years before their diagnosis, patients typically see doctors for actual symptoms of MS.

For the study – recently published in the journal Neurology – Hemmer’s team reviewed the insurance records of nearly 198,000 German adults, including 10,262 newly diagnosed with MS. The researchers looked at their doctor’s visits and diagnoses up to five years before they were diagnosed with MS and compared them to the rest of the study group.

This comparison group included people with other autoimmune diseases (Crohn’s disease or psoriasis) and people with no history of autoimmune diseases.

Overall, the study found that people who were ultimately diagnosed with MS had more medical appointments, with various specialists, than the comparison group. The biggest difference was in visits to neurologists, but they also saw urologists, ophthalmologists, orthopedists and psychiatrists among other specialists more often.

Regarding diagnoses, 43 were more common in people later diagnosed with MS, compared to people without autoimmune disease. And, said Hemmer, these were often symptoms indicative of MS, including urinary problems, visual disturbances, abnormal skin sensations, movement disturbances, and dizziness.

MS can be difficult to diagnose early on, in part because there is no single test to detect it.

“The symptoms of MS are sometimes subtle and go away on their own without any treatment,” Hemmer said. “Often these patients are not referred to a neurologist, or they cancel the appointment because the symptoms are gone.”

Dr. Andrew Solomon, neurologist and associate professor at the University of Vermont’s Larner College of Medicine, co-authored an editorial published with the study.

“There is no doubt that the delay in diagnosis is a problem,” he said, adding that the reasons “are probably many”.

On the one hand, Solomon said, “MS can look like other things, and others can look like MS.”

To diagnose the disease, he explained, doctors rely on symptoms – not just what they are, but how they appear – as well as brain MRIs or lab tests that can detect signs of central nervous system damage associated with MS.

Sometimes the process involves tracking patients over time, Solomon said.

But, he added, the delays often start earlier, with some patients not being referred to a specialist in a timely manner.

Solomon said the new findings do not rule out the idea that MS has a prodromal phase. Some patients in the study, for example, may have had such nonspecific symptoms at some point before their first neurological disturbances.

Experts want to know if there is indeed a prodromal period, because understanding the early indicators of MS could aid in a faster diagnosis.

Regardless of whether there is an MS prodrome, however, the earlier the disease is diagnosed the better, Solomon said.

There are a host of so-called disease-modifying drugs available for MS that not only control flare-ups, but can slow the progression of the disease as well. And earlier treatment, Solomon said, may have a greater impact on the risk of long-term disability.

More information

The National Multiple Sclerosis Society has more on diagnose MS.

SOURCES: Bernhard Hemmer, MD, professor and director, Neurology Clinic, Technical University of Munich, Germany; Andrew Solomon, MD, associate professor, Larner College of Medicine, University of Vermont, and neurologist, University of Vermont Medical Center, Burlington; Neurology, June 15, 2021

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