Causes of delayed diagnosis of multiple sclerosis in egypt

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A Tohamy ◽  
M S Swelam ◽  
D M Abdelgawad ◽  
H A Aref
Keyword(s):  
Multiple Sclerosis ◽  
Age At Onset ◽  
Disease Onset ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
P Value ◽  
Common Source ◽  
University Hospitals ◽  
Phone Calls ◽  
Diagnostic Delays

Abstract © 2018 Institute of Psychiatry, Ain Shams University Copyright r 2018 Institute of Psychiatry, Ain Shams University. Unauthorized reproduction of this article is prohibited. Background MS is an inflammatory and neurodegenerative disease. Early inflammatory activity might have a profound impact on the risk of developing early disability, and might be a risk factor for early transition into the progressive phase of the illness. However, there are a number of barriers implementing early MS diagnosis and treatment as the patients may delay consulting a physician about their neurological symptoms or may be reluctant to start DMT. Objective The aim of this study is to highlight the causes of delayed diagnosis of multiple sclerosis in Egypt to shorten the time of diagnosis and improve the prognosis for patients with MS. Patients and Methods Retrospective descriptive study .500 Patients coming to multiple sclerosis unit at Ain Shams University hospitals with delayed diagnosis of MS for more than 2 years had been screened. A questionnaire could be applied on 320 patients out of 500. Contacting (direct and via phone calls) the patients for evaluating the causes of delayed diagnosis of MS was done. Results In this study we found number of significant factors adversely affected a timely diagnosis including the age at onset finding that those younger at onset of MS (vs. older) experienced diagnostic delays (P-value = 0.005) and denial of symptoms which was a leading cause for delayed time to first doctor consultation and delayed diagnosis of MS (P-value =0.009). Also there was a correlation between types of MS and delayed diagnosis as we found that PPMS versus RRMS had delayed diagnosis for more than 2 years. Meanwhile, sensory symptoms at onset of the disease were associated with longer diagnostic delay. Although the first specialties the patients visit were ophthalmology and orthopedic services, that the most common Source of referral to a neurologist was suggestion by family and media. Conclusion multiple causes significantly affect time to diagnosis of MS including age at onset of the disease, denial of symptoms sensorial symptoms at the disease onset and referral delay from other specialties.

scholarly journals Multiple Sclerosis in Malaysia: Demographics, Clinical Features, and Neuroimaging Characteristics

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
S. Viswanathan ◽  
N. Rose ◽  
A. Masita ◽  
J. S. Dhaliwal ◽  
S. D. Puvanarajah ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neuromyelitis Optica ◽  
Demyelinating Disease ◽  
Age At Onset ◽  
Positive Family History ◽  
Disease Onset ◽  
Demyelinating Diseases ◽  
Lesion Length ◽  
Relapsing Remitting ◽  
Spectrum Disorders

Background. Multiple sclerosis (MS) is an uncommon disease in multiracial Malaysia. Diagnosing patients with idiopathic inflammatory demyelinating diseases has been greatly aided by the evolution in diagnostic criterion, the identification of new biomarkers, and improved accessibility to neuroimaging in the country.Objectives. To investigate the spectrum of multiple sclerosis in Malaysia.Methods. Retrospective analysis with longitudinal follow-up of patients referred to a single tertiary medical center with neurology services in Malaysia.Results. Out of 245 patients with idiopathic inflammatory demyelinating disease, 104 patients had multiple sclerosis. Female to male ratio was 5 : 1. Mean age at onset was 28.6 ± 9.9 years. The Malays were the predominant racial group affected followed by the Chinese, Indians, and other indigenous groups. Subgroup analysis revealed more Chinese having neuromyelitis optica and its spectrum disorders rather than multiple sclerosis. Positive family history was reported in 5%. Optic neuritis and myelitis were the commonest presentations at onset of disease, and relapsing remitting course was the commonest disease pattern observed. Oligoclonal band positivity was 57.6%. At disease onset, 61.5% and 66.4% fulfilled the 2005 and 2010 McDonald’s criteria for dissemination in space. Mean cord lesion length was 1.86 ± 1.65 vertebral segments in the relapsing remitting group as opposed to 6.25 ± 5.18 vertebral segments in patients with neuromyelitis optica and its spectrum disorders.Conclusion. The spectrum of multiple sclerosis in Malaysia has changed over the years. Further advancement in diagnostic criteria will no doubt continue to contribute to the evolution of this disease here.

Characteristics of multiple sclerosis in aboriginals living in British Columbia, Canada

2012 ◽  
Vol 18 (9) ◽  
pp. 1239-1243 ◽  
Author(s):  
Jameelah Saeedi ◽  
Peter Rieckmann ◽  
Irene Yee ◽  
Helen Tremlett ◽  
Keyword(s):  
Multiple Sclerosis ◽  
British Columbia ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Disease Onset ◽  
Patient Characteristics ◽  
Onset Date ◽  
Disease Course ◽  
Chi Squared ◽  
Student’S T

Objectives: The objectives of this study were to identify and describe the demographic and clinical characteristics of multiple sclerosis (MS) in aboriginals in British Columbia (BC), Canada and compare these findings with non-aboriginal MS patients. Methods: This retrospective chart and database review accessed patient information from the linked BC-wide MS clinical and genetics databases. Data gathered included: demographics (age, sex and ethnicity); clinical characteristics (MS onset date, disease course and disability scores (Expanded Disability Status Scale [EDSS]). Aboriginals were identified via the database linkage augmented by physician and nurse recall. Two non-aboriginal comparator groups with definite MS were selected. Group one included all definite MS patients in the BC MS database, and group two comprised MS patients matched by sex, age at onset and initial disease course. Patient characteristics were compared using the Student’s t-test, chi-squared test, and Kaplan–Meier survival analysis was used to examine disease progression (time to sustained and confirmed EDSS 6) Results: We identified 26 aboriginals with MS, of which 19/26 (73%) were female, 23/26 (89%) had relapsing-onset MS and a mean onset age of 31.1 years. There were no significant differences between the MS aboriginals and the non-matched ( n = 5708) comparator group with respect to age, sex or disease course ( p > 0.1), However, aboriginals progressed more rapidly to EDSS 6 from disease onset ( p < 0.001) when compared with the matched and unmatched comparator groups. Conclusion: We identified a small, but important cohort of aboriginals with MS; being the largest identified to date. There was evidence of more rapid MS progression in aboriginals compared with non-aboriginals.

Characterization of the Clinical and Laboratory Features of Primary and Secondary Antiphospholipid Syndrome in a Cohort of Egyptian Patients

2020 ◽  
Vol 16 (4) ◽  
pp. 304-310 ◽  
Author(s):  
Geilan Abd el-Moniem ◽  
Kamal El-Garf ◽  
Nesreen Sobhy ◽  
Sally Elmaghraby
Keyword(s):  
Antiphospholipid Syndrome ◽  
Age At Onset ◽  
Disease Onset ◽  
P Value ◽  
Significant Difference ◽  
Egyptian Patients ◽  
Laboratory Features ◽  
Systemic Manifestations ◽  
Males And Females

Objective: To study the clinical and laboratory features of Antiphospholipid Syndrome (APS) in a cohort of Egyptian patients and compare between primary and secondary type on the basis of clinical and immunological pattern. Patients and Methods: We reviewed the medical records of 148 antiphospholipid syndrome patients following in Rheumatology and Rehabilitation department, Cairo University. Clinical and immunological data were recorded; subsequently, our patients were compared based on the type of APS, patient’s age and sex. Results: The cohort consisted of 148 patients, 135 females (91.2%) and 13 males (8.8%). The mean age at onset was 23.6 ±7.66 years. 28.4% of patients had primary while, 71.6% of patients had secondary APS. : Patients with secondary APS presented more frequently with the following manifestations compared to patients with primary APS: systemic manifestations (56.6% versus 4.8%, P-value: 0.00), venous thrombosis (41.5% versus 19%, P-value: 0.009), cutaneous vasculitis (19.8% versus 4.8%, P-value: 0.023), thrombocytopenia (37.7% versus 11.9%, P-value: 0.002) and hemolytic anemia (28.3% versus 4.8%, P-value: 0.002). On the other hand, total obstetric manifestations were more common in primary APS (92.5% versus 75%, P-value: 0.007). : Juvenile onset APS presented more frequently with systemic (68.8%, p-value: 0.02), neurological (62.5%, p-value: 0.01) and renal manifestations (31.3%, p-value: 0.005). No statistically significant difference was found between males and females in our cohort. Conclusion: APS has broad spectrum manifestations, which may vary according to the patient’s age at disease onset and association with other diseases. Further more, different ethnicities may show different presentations.

Age at onset as a determinant of presenting phenotype and initial relapse recovery in multiple sclerosis

2011 ◽  
Vol 18 (1) ◽  
pp. 45-54 ◽  
Author(s):  
M Cossburn ◽  
G Ingram ◽  
C Hirst ◽  
Y Ben-Shlomo ◽  
TP Pickersgill ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Late Onset ◽  
Age At Onset ◽  
Disease Onset ◽  
Complete Recovery ◽  
Population Based ◽  
Disease Course ◽  
Index Event ◽  
Relapsing Remitting ◽  
Age Dependent

Background: Age at onset modifies prognosis in multiple sclerosis (MS) and may also exert an effect on the characteristics of disease ignition. Understanding how age influences presentation informs disease management and may allow differentiation of distinct clinical sub-groups. Objectives: To determine the nature of age-specific presentations of relapsing–remitting MS (RRMS) with respect to onset symptoms, gender ratios and index event outcomes. Methods: In a prospective, population-based sample of 1424 patients in South-East Wales we examined associations between age at onset, clinical features and outcome of the onset event, making specific comparisons between paediatric, adolescent and late-onset MS. Results: Age at onset varied significantly between sexes (Male 31.2, Female 29.3, p = 0.002), 0.7% had paediatric onset, 2.7% adolescent onset and 2.8% late-onset MS (>50 years). Optic neuritis was common in younger patients and declined after age 30. Lower limb motor, facial sensory, sexual and sphincteric symptoms rose with age independent of sex and disease course. F:M ratios were highest <16 years of age and declined with increasing age, with a male excess in those over 50. Probability of complete recovery from index event declined with age from 87.4% in the youngest group to 68% in the eldest ( p = 0.009). Conclusions: Age at disease onset in RRMS exerts a significant effect on gender ratios and presenting phenotype, and allows identification of specific clinical sub-groups. In addition, ability to recover from initial relapse declines with age, suggesting accumulation of disability in MS is an age-dependent response to relapse.

Effects of Age and Disease Duration on Excess Mortality in Patients With Multiple Sclerosis From a French Nationwide Cohort

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012224
Author(s):  
Fabien ROLLOT ◽  
Mathieu Fauvernier ◽  
Zoe Uhry ◽  
Sandra Vukusic ◽  
Nadine Bossard ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Excess Mortality ◽  
Disease Duration ◽  
Age At Onset ◽  
Disease Onset ◽  
Death Rates ◽  
Excess Death ◽  
Clinical Onset ◽  
Lost To Follow Up ◽  
The Impact

ObjectiveTo determine the effects of current age and disease duration on excess mortality in multiple sclerosis, we described the dynamics of excess deaths rates over these two time scales and studied the impact of age at multiple sclerosis clinical onset on these dynamics, separately in each initial phenotype.MethodsWe used data from 18 French multiple sclerosis expert centers participating in the Observatoire Français de la Sclérose en Plaques. Patients with multiple sclerosis living in metropolitan France and having a clinical onset between 1960 and 2014 were included. Vital status was updated on January 1st, 2016. For each multiple sclerosis phenotype separately (relapsing onset (R-MS) or primary progressive (PPMS)), we used an innovative statistical method to model the logarithm of excess death rates by a multidimensional penalized spline of age and disease duration.ResultsAmong 37524 patients (71% women, mean age at multiple sclerosis onset ± standard deviation 33.0 ± 10.6 years), 2883 (7.7%) deaths were observed and 7.8% of patients were lost-to-follow-up. For R-MS patients, there was no excess mortality during the first 10 years after disease onset; afterwards, whatever age at onset, excess death rates increased with current age. From current age 70, the excess death rates values converged and became identical whatever the age at disease onset, which means that disease duration had no more impact. Excess death rates were higher in men with an excess hazard ratio of 1.46 (95% confidence interval 1.25-1.70). In contrast, in PPMS patients, excess death rates rapidly increased from disease onset, and were associated with age at onset, but not with sex.ConclusionsIn R-MS, current age has a stronger impact on multiple sclerosis mortality than disease duration while their respective effects are not so clear in PPMS.

Higher weight in adolescence and young adulthood is associated with an earlier age at multiple sclerosis onset

2014 ◽  
Vol 21 (7) ◽  
pp. 858-865 ◽  
Author(s):  
Katelyn S Kavak ◽  
Barbara E Teter ◽  
Jesper Hagemeier ◽  
Karen Zakalik ◽  
Bianca Weinstock-Guttman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Young Adulthood ◽  
Symptom Onset ◽  
Age At Onset ◽  
Early Adulthood ◽  
New York State ◽  
Disease Onset ◽  
Future Research ◽  
Increased Risk ◽  
Adolescence And Young Adulthood

Background: Growing evidence suggests an association between adolescent obesity and increased risk of multiple sclerosis (MS). Objective: The objective of this paper is to investigate whether weight or body mass index (BMI) in adolescence and young adulthood was associated with age at MS symptom onset. Methods: Our cohort is comprised of a sub-group of 184 women enrolled in the New York State MS Consortium registry. Individuals were asked to recall their weight at the time of first menstruation and at age 25. BMI was calculated accordingly for age 25. Regression analyses were carried out to investigate the association between weight or BMI and age at onset. Results: Weight at menarche was significantly related to younger age at symptom onset (β = −0.073, p = 0.001). These results were also found at age 25 for weight (β = −0.080, p < 0.001) and BMI (β = −0.448, p = 0.001). Significantly earlier disease onset (26.9 years ±9.9) was observed in individuals who were overweight at 25 compared to those who were not overweight (32.1 years ±9.2, p = 0.006). Conclusions: Women who reported higher weight in adolescence and BMI in early adulthood were younger at MS onset. Future research should investigate whether there is a causal link between body weight and MS, as prevention lifestyle and dietary interventions could be implemented.

Assessment of serum zonulin as a marker of altered intestinal permeability in patients with multiple sclerosis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Prof.Dr. Ayman Mohamed Nassef ◽  
Lobna Mohamed ElNabil ◽  
Mohamed Mahmoud Fouad ◽  
Amira Ahmed Moussa
Keyword(s):  
Multiple Sclerosis ◽  
Intestinal Barrier ◽  
Control Group ◽  
P Value ◽  
University Hospitals ◽  
Control Groups ◽  
Cross Sectional ◽  
Progressive Group ◽  
And Control ◽  
Age And Sex

Abstract Background Here we enrolled patients into 3 groups: Relapsing remittent MS in relapse (RRMS) [N = 26], progressive MS (progressive) [N = 19] and relapsing remittent MS in remission (remission) [N = 18] Control group matching age and sex [N = 20] P-Value was &lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Aim of the Work To investigate the possible association between IP changes and MS through measurement serum zonulin in different population of MS for possible implication on treatment. Patients and Methods A. Subjects Type of the Study A case control observational cross sectional study Study Setting The Neurology department of Ain Shams University hospitals. Study Period 6 months to 1 year Study Population This study will enroll 92 subjects who will be divided into 4 groups; group 1 including 24patients with the diagnosis of relapsing remittent MS (RRMS) who are in relapse phase within one week from the time of sample withdrawal, group 2 including 24 patients with the diagnosis of RRMS who are in remission phase, group 3 including 24 patients with secondary progressive MS (SPMS) and group 4 including 20 age- and sex-matched healthy controls. Results In the RRMS group of this study, serum Zonulin varying between (12_ 93) with mean 28.692 and +\-22.894 SD. In the progressive group of this study, serum Zonulin varying between (2_ 18) with mean 8.021 and +\-3.866 SD. In the remission group of this study, serum Zonulin varying between (1.5_ 11) with mean 4.522 and +\-3.026 SD. In the control group of this study, serum Zonulin varying between (1.3_ 6) with mean 2.690 and +\-1.292 SD. P-Value was &lt;0.001, which is significant in RRMS group in relation to progressive, remission and control groups. P-Value was 0.849, which is insignificant in progressive group in relation to remission group. P-Value was 0.584, which is insignificant in progressive group in relation to control group. P-Value was 0.973, which is insignificant in remission group in relation to control group. Conclusion this study included 62 patients diagnosed as multiple sclerosis that are divided into 3 groups and serum Zonulin level was assessed in each group and the results were significant in the relapse group which indicates autoimmune theory of MS and link between gut barrier and CNS also illustrated the role of gut microbiota in the MS. It also supported disintegration of intestinal barrier during the attack of MS for further work up studies regarding oral medication in the acute attack of MS.

Multiple sclerosis in Pakistan

2007 ◽  
Vol 13 (5) ◽  
pp. 668-669 ◽  
Author(s):  
M. Wasay ◽  
S. Ali ◽  
I.A. Khatri ◽  
A. Hassan ◽  
M. Asif ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Age At Onset ◽  
Disease Onset ◽  
Severe Disability ◽  
Motor Weakness ◽  
Secondary Progressive ◽  
Male Ratio ◽  
Short Disease Duration ◽  
Relapsing Remitting

We describe retrospective data from the largest series of patients (n=142) with multiple sclerosis (MS) from Pakistan. Mean age at onset was 27 years, with a female to male ratio of 1.45:1. The disease onset was polysymptomatic in 75% patients. Motor weakness was the most common onset symptom (70%), followed by sensory symptoms (45%). Optico-spinal type of MS was seen in only 3% of patients The courzse was relapsing-remitting (RR) in 81%, primary progressive (PP) in 21%, and secondary progressive (SP) in 4% of patients. Almost three-fourths of the patients were moderately (45%) or severely (31%) disabled at the time of evaluation. Two-thirds of patients with severe disability had a mean disease duration of only 5.2 years. In conclusion, MS is not uncommon in Pakistan, and many patients were found to have severe disability despite short disease duration. Multiple Sclerosis 2007; 13: 668-669. http://msj.sagepub.com

Time to diagnosis in younger-onset dementia and the impact of a specialist diagnostic service

2020 ◽  
pp. 1-9
Author(s):  
Samantha M. Loi ◽  
Anita M.Y. Goh ◽  
Ramon Mocellin ◽  
Charles B. Malpas ◽  
Shaun Parker ◽  
...  
Keyword(s):  
Age At Onset ◽  
Diagnostic Delay ◽  
Cross Sectional Study ◽  
Linear Modeling ◽  
Cross Sectional ◽  
Younger Age ◽  
Time To Diagnosis ◽  
Diagnostic Delays ◽  
The Impact ◽  
Mean Time

ABSTRACT Objectives: While early diagnosis of younger-onset dementia (YOD) is crucial in terms of accessing appropriate services and future planning, diagnostic delays are common. This study aims to identify predictors of delay to diagnosis in a large sample of people with YOD and to investigate the impact of a specialist YOD service on this time to diagnosis. Design: A retrospective cross-sectional study. Setting: The inpatient unit of a tertiary neuropsychiatry service in metropolitan Victoria, Australia. Participants: People diagnosed with a YOD. Measurements and methods: We investigated the following predictors using general linear modeling: demographics including sex and location, age at onset, dementia type, cognition, psychiatric diagnosis, and number of services consulted with prior to diagnosis. Results: A total of 242 inpatients were included. The mean time to diagnosis was 3.4 years. Significant predictors of delay included younger age at onset, dementia type other than Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD), and increased number of services consulted. These predictors individually led to an increased diagnostic delay of approximately 19 days, 5 months, and 6 months, respectively. A specialized YOD service reduced time to diagnosis by 12 months. Conclusion: We found that younger age at onset, having a dementia which was not the most commonly occurring AD or bvFTD, and increasing number of services were significant predictors of diagnostic delay. A novel result was that a specialist YOD service may decrease diagnostic delay, highlighting the importance of such as service in reducing time to diagnosis as well as providing post-diagnostic support.

Long-term follow-up of benign multiple sclerosis in Hordaland County, Western Norway

2009 ◽  
Vol 15 (8) ◽  
pp. 942-950 ◽  
Author(s):  
SB Glad ◽  
HI Nyland ◽  
JH Aarseth ◽  
T Riise ◽  
KM Myhr
Keyword(s):  
Multiple Sclerosis ◽  
Prognostic Factors ◽  
Age At Onset ◽  
Disease Onset ◽  
Female Gender ◽  
Patient Treatment ◽  
Western Norway ◽  
Benign Multiple Sclerosis ◽  
Benign Course

Objective To study the frequency of benign multiple sclerosis (MS) after 20 years disease duration and identify early clinical and demographic prognostic factors of a benign course. Methods A population-based cohort including all 230 MS patients with clinical disease onset during 1976–1986 in Hordaland County, Western Norway was followed up with clinical examination in 1995 and 2003. Benign MS was defined as an Expanded Disability Status Scale (EDSS) score ≤3.0, at least 10 years after disease onset. Results A relapsing–remitting disease course at onset, female gender, and younger age at onset were significantly associated with a benign course, but could only explain 23.0% of the variation in the benign course. A low annual relapse rate was also associated with a benign course. When including this variable in the model, 42.3% of the variation could be explained. The number of benign MS cases decreased significantly from 37.6% in 1995 to 24.2% in 2003. Conclusion Benign MS is frequently a temporary condition. Only a small part of the variation in the long-term benign course could be explained by clinical data present in the early phase of the disease. With several new emerging therapies in MS, the need for more reliable prognostic factors is increasing, to improve and individualize patient treatment.

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