Gait Disorders and Depression at Onset May Delay Time to MS Diagnosis, Study Finds

Awareness of certain symptoms, particularly gait disorders and depression, could be critical for reducing the time it takes to diagnose multiple sclerosis after a patient first contacts a healthcare provider, research shows.

In the past 30 years, there has been a major decrease in the time from the onset of MS symptoms to diagnosis. However, many MS patients today still experience delays before being properly diagnosed. Four out of 10 patients report more than two years passing between symptom onset and diagnosis.

But the reasons for these delays in MS diagnosis are not fully understood. One study found that younger age at onset and having primary progressive MS were associated with longer times to diagnosis.

Other studies have found that insurance coverage, living in remote rural areas, and public transportation shortages can create major obstacles for MS patients to access proper care. Additionally, it is likely there are obstacles within the healthcare systems that can lead to a domino effect of delays in MS diagnosis.

Now, a team led by researchers at the University of Zurich in Switzerland has studied the chain of events from when a patient initially seeks care for symptoms until an MS diagnosis is confirmed.

Using data from 522 participants in the Swiss MS Registry, the team examined the steps after the first clinical contact with a healthcare provider to identify delaying factors in MS diagnosis.

“Our study is among the first to query persons with multiple sclerosis on how they responded after noticing their first symptoms,” the researchers wrote.

Results showed that patients mostly contacted their general practitioner first (67%), who often referred them to a neurologist for diagnostic testing. These patients had the same diagnostic times as those who contacted neurologists directly first.

Consistent with previous findings, PPMS was found to be a key factor in a prolonged diagnosis. Gait problems were also linked with a longer time between the first contact and first visit to a healthcare provider, whereas patients who came in with speech disorders — dysarthria — saw, on average, a shortened process.

These results suggest that the type of MS and first symptoms were crucial in prolonging the diagnostic process.

Depression was found to be another major factor in delaying the diagnostic process.

The researchers proposed several explanations for why MS patients with depression see an increased length of time until proper diagnosis and care; namely, because depression is not considered a specific MS symptom, patients might not seek immediate care due to an inability to act, and physicians might interpret symptoms as psychogenic due to depression and not MS.

Socioeconomic factors, such as lower education, living in an urban area, or having an immigrant background, were not found to play a role in a delayed diagnosis. However, researchers did find that people living in the Swiss mountains had a longer time to MS diagnosis, likely due to the lack of available care.

These findings suggest that patients need to be carefully assessed for gait symptoms upon initial contact with their general practitioner or neurologist. Similarly, an attentive follow-up of possible MS cases with depression as a concomitant first symptom is needed.

“For a quicker diagnosis, awareness of MS as a differential diagnosis of gait disorders and the co-occurrence of depression at onset should be raised, and these symptoms should be attentively followed,” the researchers wrote.

“Moreover, the potential causes for initial inactivity by first healthcare providers deserve further investigation and may lie in unusual symptom combinations, lack of awareness for multiple sclerosis, or problems in patient-doctor communication,” they added.

They also suggested that to potentially accelerate the diagnostic process, “future research should examine the reasons why patients may not seek immediate care after the first onset of MS symptoms.”