Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis

Gasperi, Christiane; Hapfelmeier, Alexander; Daltrozzo, Tanja; Schneider, Antonius; Donnachie, Ewan; Hemmer, Bernhard

doi:10.1212/wnl.0000000000012074

Cited by 24 publications

(30 citation statements)

References 25 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Firstly, we confirmed previous findings identifying a list of different symptoms more frequently encountered in the preclinical period before MS onset compared to the general population [1,2,8]. They included headaches, ophthalmic, musculoskeletal, cardiovascular, digestive, urinary, laryngological, and mental complaints.…”

Section: Discussionsupporting

confidence: 88%

Gender-Related Differences in Prodromal Multiple Sclerosis Characteristics: A 7-Year Observation Study

Perwieniec

Podwójcic

Maluchnik

et al. 2021

JCM

View full text Add to dashboard Cite

Increasing evidence supports the observation that multiple sclerosis (MS) has a preclinical period, with various prodromal signs and symptoms more frequently represented in patients with confirmed MS many years later. Considering the apparent gender differences in the incidence and clinical course of MS, it remains unclear whether it could be reflected in prodromal symptom features. This study aimed to compare a broad spectrum of prodromal signs and symptoms between males and females in the 7-year period before the definite diagnosis of MS. Data came from the central register of the national payer of services, financed under the public healthcare system in Poland. They covered a 7-year period of patient health record claims, from 2009 to 2016. The following groups of symptoms were significant with women: musculoskeletal (p < 0.001), ophthalmic (p < 0.001), laryngological (p < 0.001), digestive system (p < 0.001), urinary tract (p < 0.001), mental (p < 0.001), cardiovascular (p < 0.001), complaints and headaches (p < 0.001). There was also a weak correlation with head injuries (p = 0.03) while dermatological and reproductive system complaints did not appear to be significant (p < 0.05). For males, the following groups of symptoms were significant: musculoskeletal (p < 0.001), ophthalmic (p < 0.001), laryngological (p = 0.007), cardiovascular system symptoms (p < 0.001), and headaches (p < 0.001). Interestingly, reproductive system problems were overrepresented in the male population (p = 0.008). There was no significant correlation with MS risk for dermatological, digestive, urinary, and mental complaints. Similarly, head injuries were not significant. Our results shed more light on well-known differences in the epidemiological and clinical characteristics between sexes in multiple sclerosis, and show differences in prodromal complaints before MS onset.

show abstract

Section: Discussionsupporting

confidence: 88%

Gender-Related Differences in Prodromal Multiple Sclerosis Characteristics: A 7-Year Observation Study

Perwieniec

Podwójcic

Maluchnik

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…In recent years, evidence has emerged of a measurable, symptomatic phase of MS that precedes the classic understanding of MS disease onset, a period known as a prodrome (1). Several studies have found increased total and condition-specific health-care utilization in the years preceding MS onset and diagnosis (1)(2)(3)(4)(5)(6). Biological changes are also evident during this period, including higher serum neurofilament light levels up to 6 years before MS symptom onset (vs. matched persons without MS) (7).…”

Section: Introductionmentioning

confidence: 99%

Sex and age differences in the Multiple Sclerosis prodrome

Yusuf

Wijnands²,

Karim³

et al. 2022

Front. Neurol.

View full text Add to dashboard Cite

Background and objectivesLittle is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome.MethodsThis was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event (“administrative cohort;” n = 6,863) or MS symptom onset (“clinical cohort;” n = 966) were compared to age-, sex- and geographically-matched controls (n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30–49, ≥50 years).ResultsIn the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30–49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30–49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30–49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30–49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30–49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance (P ≥ 0.05).DiscussionSex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.

show abstract

“…Previous studies raised the hypothesis of the existence of a prodromal phase of MS. 17 – 19 In our previous study, however, we found evidence for demyelinating events explaining the observed increased use of the healthcare system of patients with MS in the years before diagnosis. 13 The characteristics and the duration of a hypothesized prodromal phase of MS are currently unknown. While our results suggest that the association of pregnancies and MS risk precede the disease or a phase with ongoing but undiagnosed disease, we cannot fully exclude the possibility that a prodromal phase with yet-to-be-defined clinical features might have an effect on pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study, we observed higher recording rates for 43 ICD-10 codes for patients with MS as compared to controls in the 5 years before diagnosis. 13 Many of these are neurological or neurovascular ICD-10 codes or correspond to symptoms that could represent demyelinating events. We, therefore, performed a sensitivity analysis where we removed women with recorded neurological or neurovascular ICD-10 codes or codes suggestive of demyelinating events and associated with MS in our previous study 13 in the 5 years before diagnosis ( Supplementary Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

Association of pregnancies with risk of multiple sclerosis

Gasperi

Hapfelmeier

Schneider³

et al. 2022

Mult Scler

Self Cite

View full text Add to dashboard Cite

Background: Pregnancies have an impact on the disease course of multiple sclerosis (MS), but their relationship with MS risk is yet unclear. Objective: To determine the relationships of pregnancies and gynecological diagnoses with MS risk. Methods: In this retrospective case–control study, we assessed differences in gynecological International Classification of Diseases, 10th Revision (ICD-10) code recording rates between women with MS ( n = 5720), Crohn’s disease ( n = 6280), or psoriasis ( n = 40,555) and women without these autoimmune diseases ( n = 26,729) in the 5 years before diagnosis. Results: Twenty-eight ICD-10 codes were recorded less frequently for women with MS as compared to women without autoimmune disease, 18 of which are pregnancy-related. After adjustment for pregnancies, all codes unrelated to pregnancies were still negatively associated with MS. In a sensitivity analysis excluding women with evidence for possible demyelinating events before diagnosis, all associations were more pronounced. In comparison to women with psoriasis, most associations could be confirmed; that was not true in comparison to women with Crohn’s disease. Conclusion: Our findings provide evidence for a possible protective effect of pregnancies on MS risk likely independent of or in addition to a previously suggested reversed causality. The negative associations of gynecological disorders with disease risk need further investigation. The associations might be shared by different autoimmune diseases.

show abstract

Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis

Cited by 24 publications

References 25 publications

Gender-Related Differences in Prodromal Multiple Sclerosis Characteristics: A 7-Year Observation Study

Gender-Related Differences in Prodromal Multiple Sclerosis Characteristics: A 7-Year Observation Study

Sex and age differences in the Multiple Sclerosis prodrome

Association of pregnancies with risk of multiple sclerosis

Contact Info

Product

Resources

About