Neurologists are calling for general practitioners (GPs) and primary care providers (PCPs) to refer people with symptoms suggestive of multiple sclerosis (MS) promptly to a neurologist – preferably one with a special interest in the disease.
Long delays in referral to an MS neurologist result in delayed diagnosis of MS and are associated with greater levels of disability at the first clinic visit.1
New research, presented at the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 2017 by Professor Jeremy Hobart, recommends that anyone who reports symptoms that might be related to MS to a healthcare professional, should be referred to a neurologist within 10 days.2 In addition, a diagnostic workup for MS should be completed within 4 weeks of referral to a neurologist. These time frames were judged by a global panel of experts to be a realistic target in most healthcare systems.
Specific data for times between first consultation with a PCP (potentially relevant to MS) and referral to a neurologist are not currently easily available. However, recently published data from almost 17 000 people with MS across Europe show that the gap between the start of symptoms and diagnosis varies considerably between countries, and is far short of the recommended standard.3
“General practitioners and primary care providers play a critical role in establishing a timely diagnosis and referring patients promptly to a neurologist because they are usually the first to encounter people with symptoms suggestive of MS,” said Professor Anthony Traboulsee, University of British Columbia, Canada, and lead author of a Time matters in multiple sclerosis: diagnose early to maximize brain health, a guide for GPs and PCPs.
“The pace of changes in treatment options and monitoring processes is fast and exciting, with many highly effective disease-modifying treatments now available,” added Professor Helmut Butzkueven, joint head of MS Services at Royal Melbourne Hospital, Australia. “Timely diagnosis and referral are critical in protecting brain health and improving outcomes for people with MS.”
UK-based co-author, Dr Colin Bannon, who was a GP for 25 years and is someone who has MS, said: “With treatment options racing ahead, it’s important for GPs to be vigilant when seeing patients with neurological symptoms, and to urgently refer anyone with suspected MS. I hope this concise publication will help GPs develop an encouraging and optimistic approach to the diagnosis and management of MS. With growing evidence for the benefits of treatment – and the earlier the treatment the better – this energetic and positive approach will significantly improve the lives of people with MS."
The short guide has been developed by the authors of the policy report Brain health: time matters in multiple sclerosis, together with Dr Colin Bannon, and explains how the recommendations from that report can be put into practice by GPs and PCPs through:
- ensuring a high index of suspicion of MS
- referring people with suspected MS to a neurologist
- providing shared care, support and monitoring.
- Kingwell E, Leung AL, Roger E et al. Factors associated with delay to medical recognition in two Canadian multiple sclerosis cohorts. J Neurol Sci 2010;292:57–62; doi:10.1016/j.jns.2010.02.007.
- Hobart J et al. Expert consensus on standards for multiple sclerosis care: results from a modified Delphi process [poster]. Presented at the 7th Joint ECTRIMS–ACTRIMS meeting, 25–28 October 2017, Paris, France.
- Kobelt G, Thompson A, Berg J et al. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler 2017;23:1123–36; doi:10.1177/1352458517694432.