Factors Affecting Time Elapsed from First Symptom till Complete Diagnosis of Multiple Sclerosis, Initiation of Disease Modifying Treatment and Drug Adherence in Upper Egypt

Multiple sclerosis (MS) is a chronic progressive autoimmune inflammatory disorder of the central nervous system, with marked social and economic consequences. It is the leading cause of non-traumatic disability among productive young and middle-aged adults, affecting up to 2.22 million people worldwide. Although there is no cure for MS, marked evolution has been made in the disease modifying treatments (DMT) that can alter the disease course. The earlier that MS can be diagnosed; the sooner treatment can be initiated with timely prevention of disability progression. However, significant delays can still occur between noticing the first symptoms and receiving a diagnosis. Such delays could be due to heterogeneity of clinical and imaging manifestations, lack of awareness of the primary care physicians, the limited accessibility to specialized centers or the non-availability of diagnostic tools. Moreover, delayed initiation of DMT after diagnosis may be related to factors including the inadequate knowledge with DMT and their high coast. Like many chronic conditions, non-Adherence to drug therapies is estimated up to 50%, with increased morbidity, mortality, and health care costs. Therefore, particularly for populations with limited resources, early identification and management of factors leading to delayed diagnosis of MS, initiation, and adherence to DMT is the best strategy that will be reflected on patients, their families and society.