Who visits an MS clinic?
An Italian study has found that the people visiting MS clinics have changed over the past 20 years (Bergamaschi and colleagues. Neurol Sci 2022;43:5459-5469). The analysis included over 35,000 people who first went to an MS clinic in Italy, Sicily or Sardinia in the year 2000 or thereafter.
Over the 20-year period, most people first visited an MS clinic with relapsing-remitting MS (RRMS, 67%) or clinically isolated syndrome (CIS, 26%), a new diagnosis two decades ago. CIS is when a person has MS-like symptoms but does not meet the full criteria (such as MRI lesions) for an MS diagnosis. Few people at the first visit had primary-progressive MS (5%) or secondary-progressive MS (2%) and that proportion has decreased since 2000-2010, which may mean that they are being identified earlier and managed in the community.
While there has been a great deal of discussion about early diagnosis of MS, 52% of people visiting a clinic for the first time were aged 35 years or older, and 61% of people with RRMS had been living with symptoms for over a year. Men were much more likely than women to go to a clinic with a progressive form of MS, which may suggest they are more likely to put off a visit to the doctor. In 53% of cases there were difficulties accessing an MS medication, which was due to differing drug reimbursement policies – especially for people with progressive MS – across the various regions in Italy.
It is important to note that this study specifically involved MS clinics. The many people with CIS were likely referred to the clinic by a GP or community neurologist to confirm the diagnosis. A smaller proportion of people had CIS in more recent years, which may indicate that community neurologists have gotten more confident in diagnosing CIS. Similarly, some of the apparent diagnostic delay may actually be a delayed referral to a clinic; a community neurologist may diagnose and manage MS, only referring people to an MS clinic when it is time to start an MS medication.
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