Presentation on theme: "Symptoms to Diagnosis in Multiple Sclerosis Crawford A, Kielt C, MacLurg K, Reilly P, Hawkins SA, Queens University Belfast 1. Age of patient at 1 st presentation."— Presentation transcript:
Symptoms to Diagnosis in Multiple Sclerosis Crawford A, Kielt C, MacLurg K, Reilly P, Hawkins SA, Queens University Belfast 1. Age of patient at 1 st presentation to GP with relevant symptom (p<0.05) Figure 4 shows a general decrease in length of time from first symptom to diagnosis with increasing age particularly for men. 2. Category of multiple sclerosis (p<0.01) Table 1 shows the number, and percentage, of patients in each group against the length of time from first symptom to diagnosis subdivided into three. Table 1 3. Year in which patient presented with first symptom (p<0.05) Figure 5 is a scatter graph of the year of the first symptom plotted against our outcome measure. It could be misleading as someone who had their first symptom in 1995 and was going to take more than five years to be diagnosed would not be included. Analysis of a subgroup was undertaken to examine any effect Poser’s publication of diagnostic criteria for MS had had on our outcome measure. Table 2 shows the result which is statistically significant.. 4. The type of symptoms prior to diagnosis (p<0.01) A wide range of symptoms was recorded prior to diagnosis. These are summarised in Table 3. We found that the relationship of the following four variables to our outcome measure reached statistical significance. Figure 1 Figure 3 Figure 4 Figure 5 Conclusion: This research has highlighted some new, previously unidentified factors which may lead to the delay in diagnosis of MS. Interestingly the age of the patient and the type of symptom they present with are important. Sensory and optic symptoms are often intermittent with a wide differential diagnosis whereas brainstem symptoms may cause greater concern. Older patients are diagnosed more quickly. Seeing a neurologist first was not shown to improve the speed of diagnosis. Acknowledgements: Funding was provided by the Multiple Sclerosis Society (GB &NI) Table 3 Background Multiple sclerosis (MS) the most common disabling neurological disease of young adults in developed countries 1 and Northern Ireland has been identified as an area of high prevalence (168 per 100,000). 2 Long delays between onset of symptoms and diagnosis have been reported 1 and a vast variation in this is often accepted as normal. Patients would prefer a clear diagnosis quickly 3,4 but symptoms which appear relevant in retrospect may initially be seen as unimportant. MS may be suspected years before there is sufficient evidence to make a definite diagnosis. 3 Shortening this delay is important because new disease-modifying drugs may be most effective early in the course of the disease 1 and because the path to diagnosis is comprised of worrying, wondering and waiting. 5 Diagnostic criteria aim to aid diagnosis and end the uncertainty for the patient. 6 We hoped that identifying factors involved might ultimately aid the speed of diagnosis of MS. Objective To investigate factors which influenced the length of time from first presentation to a general practitioner (GP) with relevant symptoms to a definitive diagnosis of MS. M ethod This study is part of a larger research project carried out using the DRGP. The DRGP is a network of computerised practices situated across the province with a patient profile broadly representative of the population. GPs in these practices identified patients with MS from whom consent was obtained. Medical Records of participants were examined and specified details noted. The diagnosis of MS was verified from hospital letters. Data was recorded and analysed using SPSS(v11.0) Results 157 participants had a definitive diagnosis of MS. 34% male : 66% female. Figure 1 shows their age distribution. Figure 2 Figure 2 shows the percentage of participants within each category of MS Figure 3 is a histogram of our outcome measurement. Category of MS n Number of Years from 1 st symptom to diagnosis <55-10>10 Benign 17 6 (35%)3 (18%)8 (47%) 1 progressive 22 21 (95%)1 (5%)0 2 progressive 59 43 (73%)9 (15%)7 (12%) Relapsing remitting 59 45 (76%)8 (14%)6 (10%) Year of 1 st Symptom n Number of Years from 1 st symptom to diagnosis <3<34-6 1975-1984 36 2511 1985-1994 48 426 Table 2 Symptoms prior to diagnosis Number (%) with this symptom Number (%) with only this symptom Sensory85 (56%)22 (14%) Motor67 (44%)28 (18%) Optic65 (42%)10 (7%) Brainstem23 (15%)3 (2%) Other21 (14%)0 Presenting with sensory, optic, brainstem or other symptoms was significantly related to length of time from first symptom to diagnosis. Having sensory or optic symptoms increased the length of time to diagnosis. Having motor, brainstem or other symptoms decreased the time to diagnosis. 1. Age of patient at first presentation to GP with relevant symptom (p<0.05) 2. Category of multiple sclerosis (p<0.01) 3. Year in which patient presented with first symptom (p<0.05) 4. The type of symptoms prior to diagnosis (p<0.01) Other variables examined where any differences did not reach statistical significance were sex of the patient number of symptoms at first presentation to GP whether or not they saw a Neurologist first Outcome Measurement The length of time from first symptom to diagnosis of MS References 1.McDonnell G.V. and Hawkins S.A. (2000) Multiple Sclerosis in Northern Ireland: A historical and global perspective”, TheUlster Medical Journal, 69(2), pp97- 105. 2.McDonnell G.V. and Hawkins S.A. (1998) “An epidemiologic study of multiple sclerosis in Northern Ireland.” Neurology, 50, pp 423-428. 3.Benz C. (1993) Coping with MS. Optima, London pp22. 4.Guillem-Mesado A. de Andres C. Lopez-Longo J. Gimenez-Roldan S.(1998) “Information about the diagnosis: a subjective experience of patients with multiple sclerosis and rheumatoid arthritis.” Revista de Neurologia. 26 (149) pp25-8 5.Koopman, W. and Scweitzer, A. (1999) “The journey to multiple sclerosis: a qualitative study.” Journal of Neuroscience Nursing, 31(1), pp17-26. 6.Poser, C. Paty, D. Scheinberg, L. Davis, F. Ebers, G. Johnson, K. Sibley, A. Silbereberg, D. Tourtellotte, W. (1983) “New Diagnostic Criteria for Multiple Sclerosis: Guidelines for Research Protocols”, Annals of Neurology, 13(3), pp 227-231.