Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Kaufmann, Marco; Kuhle, Jens; Puhan, Milo A.; Kamm, Christian P.; Chan, Andrew; Salmen, Anke; Kesselring, Jürg; Calabrese, Pasquale; Gobbi, Claudio; Pot, Caroline; Steinemann, Nina; Rodgers, Stephanie; Wyl, Viktor von

doi:10.1177/2055217318814562

Cited by 21 publications

(30 citation statements)

References 28 publications

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“…The delaying effect of gait problems might appear to contradict the findings of Kaufmann et al, 3 where they were associated with a quicker diagnostic process. However, in our study, gait problems were associated with a longer contact-to-evaluation phase, but not a longer evaluation-to-diagnosis phase.…”

Section: Discussionmentioning

confidence: 58%

“…Our finding of longer diagnostic times in patients with PPMS confirms those reported in other studies. 3,10 The delaying effect of having PPMS on the time from the first evaluation to diagnosis possibly reflects the requirement of McDonald diagnostic criteria, which require 1 year of confirmed progression for this MS type. However, because delays in PPMS were also statistically significantly longer in the first phase of the diagnostic cascade (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Kingwell et al pursued a systematic approach to identify the factors associated with the diagnostic time, but did not include sociodemographic factors, access barriers, and features of the diagnostic cascade in their assessment. Recently, Kaufmann et al 3 investigated this question using SMSR data, but without distinguishing between the different diagnostic process phases, instead modeling the whole diagnostic time at once.…”

Section: Discussionmentioning

confidence: 99%

“…For each logistic regression model, the potential factors were added to the fixed factors in a stepwise approach based on Akaike information criterion (AIC). 3 Missing information (ranging from 0.1% to 5% per variable) were imputed by means of the multivariate imputation by chained equations (MICE) algorithm. 14 The entire analysis was performed using R, version 3.4.0.…”

Section: Identification Of the Factors Associated With Prolonged Diagmentioning

confidence: 99%

“…Nevertheless, a substantial number of patients still experience significant delays before receiving a definite diagnosis. A Swiss study by Kaufmann et al 3 found that-even in recent time periods-40% of all newly diagnosed persons with MS reported more than 2 years passing between symptom onset and the MS diagnosis. This is even more relevant in light of the mounting evidence on the benefits of early treatment initiation in relapsing remitting multiple sclerosis (RRMS) to prevent long-term disability.…”

Section: Introductionmentioning

confidence: 99%

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How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis

et al. 2019

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Background: Diagnosing multiple sclerosis (MS) early is crucial to avoid future disability. However, potentially preventable delays in the diagnostic cascade from contact with a physician to definite diagnosis still occur and their causes are still unclear. Objective: To identify the possible causes of delays in the diagnostic process. Methods: We analyzed the data of the Swiss MS Registry. With logistic regression, we modeled the time from the first contact to the first consultation (contact-to-evaluation time, ⩽1 month/>1 month) and the evaluation-to-diagnosis time (⩽6 months/>6 months). Potential factors were health system characteristics, sociodemographic variables, first symptoms, and MS type. Results: We included 522 participants. Mostly, general practitioners (67%) were contacted first, without delaying the diagnosis. In contrast, first symptoms and MS type were the major contributors to delays: gait problems were associated with longer contact-to-evaluation times, depression as a concomitant symptom with longer evaluation-to-diagnosis times, and having primary progressive MS prolonged both phases. In addition, living in mountainous areas was associated with longer contact-to-evaluation times, whereas diagnosis after 2000 was associated with faster diagnoses. Conclusion: 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.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Identification Of the Factors Associated With Prolonged Diagmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis

et al. 2019

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Prior optic neuritis detection on peripapillary ring scans using deep learning

Motamedi

Yadav

Kenney

et al. 2022

Ann Clin Transl Neurol

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Background: The diagnosis of multiple sclerosis (MS) requires demyelinating events that are disseminated in time and space. Peripapillary retinal nerve fiber layer (pRNFL) thickness as measured by optical coherence tomography (OCT) distinguishes eyes with a prior history of acute optic neuritis (ON) and may provide evidence to support a demyelinating attack. Objective: To investigate whether a deep learning (DL)-based network can distinguish between eyes with prior ON and healthy control (HC) eyes using peripapillary ring scans. Methods: We included 1033 OCT scans from 415 healthy eyes (213 HC subjects) and 510 peripapillary ring scans from 164 eyes with prior acute ON (140 patients with MS). Data were split into 70% training, 15% validation, and 15% test data. We included 102 OCT scans from 80 healthy eyes (40 HC) and 61 scans from 40 ON eyes (31 MS patients) from an independent second center. Receiver operating characteristic curve analyses with area under the curve (AUC) were used to investigate performance. Results: We used a dilated residual convolutional neural network for the classification. The final network had an accuracy of 0.85 and an AUC of 0.86, whereas pRNFL only had an AUC of 0.77 in recognizing ON eyes. Using data from a second center, the network achieved an accuracy of 0.77 and an AUC of 0.90 compared to pRNFL, which had an AUC of 0.84. Interpretation: DL-based disease classification of prior ON is feasible and has the potential to outperform thickness-based classification of eyes with and without history of prior ON.

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Computer-Aided Diagnosis and Prediction in Brain Disorders

et al. 2023

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Computer-aided methods have shown added value for diagnosing and predicting brain disorders and can thus support decision making in clinical care and treatment planning. This chapter will provide insight into the type of methods, their working, their input data –such as cognitive tests, imaging, and genetic data– and the types of output they provide. We will focus on specific use cases for diagnosis, i.e., estimating the current “condition” of the patient, such as early detection and diagnosis of dementia, differential diagnosis of brain tumors, and decision making in stroke. Regarding prediction, i.e., estimation of the future “condition” of the patient, we will zoom in on use cases such as predicting the disease course in multiple sclerosis and predicting patient outcomes after treatment in brain cancer. Furthermore, based on these use cases, we will assess the current state-of-the-art methodology and highlight current efforts on benchmarking of these methods and the importance of open science therein. Finally, we assess the current clinical impact of computer-aided methods and discuss the required next steps to increase clinical impact.

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Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Cited by 21 publications

References 28 publications

How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis

How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis

Prior optic neuritis detection on peripapillary ring scans using deep learning

Computer-Aided Diagnosis and Prediction in Brain Disorders

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