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

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.”

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5 comments

  1. Karen Beaumont says:

    As MS has no cure it is not possible to receive treatment, so you just have to live with gait ataxia and live in hope.

  2. I just had to snort when reading this. Apparently a very critical question was not asked…How many weeks (months?) was it between the request to see an MS specialist and actually seeing one? If a person is in relapse and recovery the symptoms may be absolutely not present when the actual MS doc is seen. Then, of course, it is all in the patient’s head (and so it is actually) or in their spinal cord. Trying to get a second visit will be most often impossible.
    However, if a person with MS is delayed long enough, not being able to walk (i.e is in progressive MS) for example, so they “crawl” to the next meeting with an MS specialist. Then the MS specialist may just dismiss it as “hysterics”…how does one know what kind of so-called MS specialist that doc is?
    I have had all kinds and if I ever have to live this life over, I will demand to see credentials, lists of publications, patient comments, etc.
    My aversion to MS doctors is profound and I avoid them as much as possible.
    I now have an excellent MS Doc and he deals in RRMS and systemic progressive MS . He is truly helpful, really listens (OMG), and has successfully convinced me to try a new drug which has been markedly helpful. His practice bridges VA and local, public, large hospital care, so maybe that made the difference.

  3. Martin Read (UK) says:

    In the UK, I was given a diagnosis of MS, after a second defined relapse, four years on from my second symptoms making themselves known. But then a second neurologist expressed ‘concerns’ that I might have been misdiagnosed, and he gave me the impression that a ‘redefined progn’ might equate to a ‘potential cure.’
    I underwent a second scan, and it was explained that the neurologist thought there was good reason to doubt that I had MS, based upon indistinct lesions at the base of my brain. But no further tests or alternative diagnoses were ever proffered. There followed a sense of abandonment.
    I believe that my ‘possible MS’ label has been the means by which I have been denied a number of health concessions, initially whilst still working, then on and into my unenhanced early retirement. Although a full MS ‘cure’ continues to evade modern science there would initially have been a number of funded measures that might have improved my life in a variety of ways.
    It has taken a further twenty years, simply to have an official diagnosis reapplied. Soon, after having initially been reassessed, it transpired that all the pertinent parties recognised that I was almost certainly undergoing an MS deterioration, and yet the ‘possible’ prefix was time and again permitted to undermine any sought concessions.
    Now that I am again an official MS sufferer the UK’s austerity programme has effectively stripped away any significant available support. It is difficult not to draw the obvious conclusion that my rediagnosis was politically and economically driven.

  4. Broce says:

    I was diagnosed in December of 2008. Unfortunately, that was twenty six years after my original symptoms, and I am now housebound and Secondary Progressive.

    Women are often not listened to when they appear with complaints. To be sure, my MS presented somewhat unusually in that extreme spasticity in my back was the beginning. However, over the intervening years, I developed more easily recognizable symptoms, but none of those prompted any testing by the various doctors I consulted. It was all in my head, it was stress, I must be depressed and not know it, all women have pain, maybe my shoes didn’t fit me correctly, etc. etc. etc. Not a single x-ray was taken, never a suggestion that perhaps an MRI might help. Not doctor so much as touched me to investigate my myriad symptoms.

    Meanwhile, the disease ran rampant in my body, free to damage as it chose. It was not until my eyesight was impacted that anyone even considered there might be a real problem, and even then, it was my optometrist who figured out that it was probably MS. The full physical I had had just two weeks before had turned up nothing, according to the doctor, who was a bit apologetic when he realized what he had missed.

    Doctors need to *listen* to women. My life has been destroyed by this disease. Had I been on a disease modifying treatment when they first it the market, I would still be earning a six figure income, rock climbing for fun, and being an active and contributing member of society. Doctors are very quick to dismiss women’s health complaints by assuming that we are, instead of being ill, just making a mountain out of a molehill and unable to manage stress. It is infuriating.

    • ccheri says:

      I feel your pain. I’m going on 12 yrs without a diagnosis of MS. They diagnosis me with Functional Neurological Disorder- otherwise known as conversion disorder. I won’t deny it looks like that, and I could have it;BUTon my MRI it shows lesions and spinal cord issues. Get this with all of them seeing my MRI from February 2018- my psychiatrist, a nurse, a physical therapist, and a chiropractor , said I had MS;it even says it on the MRI. But, the neurologist says I have FND because that’s what all the previous ones said. The neurologist says go to the psychiatrist and the psychiatrist says go to the neurologist. This has destroyed my life, I’ve lost my career, home, and family n friends over this time and time again. My symptoms are visible, chronic and acute spasity , problems walking, sitting, cognitive, memory, depression n anxiety, and talking; nobody cares nor believes me because of the diagnose indicates it’s a mental problem. Anyways, I haven’t came across anyone else, that’s been through it like me, so thanks for sharing your story, I felt like the only one and I truly feel for you.

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