Neuropsychiatric Department, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt.
Neuropsychiatric Department, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.
Sci Rep. 2023 Feb 8;13(1):2249. doi: 10.1038/s41598-023-28864-x.
The earlier the diagnosis of multiple sclerosis (MS), the sooner disease-modifying treatments can be initiated. However, significant delays still occur in developing countries. We aimed to identify factors leading to delayed diagnosis of MS in Upper Egypt. One hundred forty-two patients with remitting relapsing MS (RRMS) were recruited from 3 MS units in Upper Egypt. Detailed demographic and clinical data were collected. Neurological examination and assessment of the Disability Status Scale (EDSS) were performed. The mean age was 33.52 ± 8.96 years with 72.5% of patients were females. The mean time from symptom onset to diagnosis was 18.63 ± 27.87 months and the median was 3 months. Seventy-two patients (50.7%) achieved diagnosis within three months after the first presenting symptom (early diagnosis), while seventy patients (49.3%) had more than three months delay in diagnosis (delayed diagnosis). Patients with a delayed diagnosis frequently presented in the period before 2019 and had a significantly higher rate of initial non-motor presentation, initial non-neurological consultations, prior misdiagnoses, and a higher relapse rate. Another possible factor was delayed MRI acquisition following the initial presentation in sixty-six (46.5%) patients. Multivariable logistic regression analysis demonstrated that earlier presentation, initial non-neurological consultation, and prior misdiagnosis were independent predictors of diagnostic delay. Despite advances in MS management in Egypt, initial non-neurological consultation and previous misdiagnoses are significant factors responsible for delayed diagnosis in Upper Egypt.
多发性硬化症（MS）的诊断越早，就能越早开始采用疾病修正治疗。然而，在发展中国家，仍然存在显著的延迟。我们旨在确定导致上埃及 MS 诊断延迟的因素。从埃及上埃及的 3 个 MS 单位招募了 142 名缓解复发型 MS（RRMS）患者。收集了详细的人口统计学和临床数据。进行了神经学检查和残疾状况量表（EDSS）评估。平均年龄为 33.52±8.96 岁，其中 72.5%的患者为女性。从症状出现到诊断的平均时间为 18.63±27.87 个月，中位数为 3 个月。72 名患者（50.7%）在首次出现症状后 3 个月内获得诊断（早期诊断），而 70 名患者（49.3%）在诊断上有超过 3 个月的延迟（延迟诊断）。诊断延迟的患者经常在 2019 年之前出现，初始非运动表现、初始非神经科就诊、先前误诊和更高的复发率的发生率显著更高。另一个可能的因素是 66 名患者（46.5%）在初始表现后 MRI 采集延迟。多变量逻辑回归分析表明，更早的就诊、初始非神经科就诊和先前误诊是诊断延迟的独立预测因素。尽管埃及在 MS 管理方面取得了进展，但初始非神经科就诊和先前误诊是导致上埃及诊断延迟的重要因素。
