Detection Barriers of Multiple Sclerosis on Disease Progression and Management

A Systematic Review

Abstract

A systematic review of the literature was conducted to examine the independent barriers and clinical implications of delaying the detection and multifaceted treatment of Multiple Sclerosis (MS), a potentially disabling, inflammatory autoimmune disease predominantly affecting the CNS (National Institute of Neurological Disorders and Stroke, 2020). Further, the significance of detecting neurocognitive impairments to inform diagnosis and monitor decline as the disease progresses was explored. An in-depth qualitative analysis was performed to appraise the collected research and establish generalizability of homogenous findings across studies. Findings suggest that the heterogenous makeup of MS serves as the predominant barrier in obtaining subclinical or an early definite diagnosis, with earlier initiation of disease-modifying treatments (DMTs) exhibiting long-term benefits in patients with relapse-remitting subtypes (Schwenkenbecher et al., 2019; Eccles, 2019; Miller, 2004; Rolak, 2003; Waubant, 2012). The greatest occurrences of diagnostic errors were reported across numerous studies to have been induced by misinterpretation of MRI lesions, atypical clinical manifestations, and inaccurate determination of alternate conditions due to congruent CNS presentations (Solomon et al., 2016; Calabrese et al., 2019; Schwenkenbecher et al., 2019; Rolak, 2003). Several studies indicated that early detection of cognitive decline via the administration of screenings in the initial work-up and post-onset to clinically monitor patients through disease transition, may assist in informing diagnosis, determining eligibility for participation in neurocognitive trainings, and properly allocating psychological resources as needed, thus, enhancing their quality of life (Foley et al., 2012; Kalb et al., 2018; Islas & Ciampi, 2019; Oreja-Guevara et al., 2019).

Keywords: Multiple sclerosis, neurodegeneration, myelinating disorder, disease-modifying treatments, relapse-remitting, primary progressive, autoimmune condition