Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis

Area of Science:

• Neurology
• Clinical Medicine

Background:

• Secondary progressive multiple sclerosis (SPMS) is characterized by disease progression independent of relapses.
• The clinical definition of SPMS is often difficult to apply in practice, leading to delayed diagnosis.
• Early identification of SPMS is crucial for appropriate patient management and research.

Purpose of the Study:

• To determine the duration of the transition period from relapsing-remitting multiple sclerosis (RRMS) to SPMS in clinical practice.
• To characterize the diagnostic uncertainty associated with this clinical phenotype change.

Main Methods:

• Retrospective review of 123 patients with long-term follow-up.
• Identification of a subgroup transitioning from RRMS to SPMS.
• Characterization of the transition period, including instances of diagnostic uncertainty.

Main Results:

• A significant period of diagnostic uncertainty was observed in patients transitioning from RRMS to SPMS.
• 14 out of 20 transitioning patients exhibited uncertainty regarding their clinical phenotype.
• The mean duration of this period of uncertainty was 2.9 ± 0.8 years.

Conclusions:

• A notable diagnostic uncertainty exists when classifying the transition from RRMS to SPMS.
• Subtle early progression, treatment limitations, and payer concerns contribute to delayed SPMS diagnosis.
• Delayed SPMS identification has implications for patient care, treatment strategies, and clinical research.