Brainstem syndrome at onset is related to an early MS diagnosis in Peru: A national referral center cohort

Background: MS is unpredictable regarding clinical symptoms; however, certain symptoms represent the preferred localization of white matter lesions such as brainstem, spinal cord; or optic nerve. Objectives: To investigate the epidemiological, clinical, and imaging characteristics of MS patients in a national referral center in Peru, and to evaluate whether the type of symptom at onset relates with the time to making an MS diagnosis.Methods: Retrospective study of MS patients at the Instituto Nacional de Ciencias Neurológicas between January 2010 and December 2018. Four different syndromes were selected for analysis as symptom onset (optic neuritis,brainstem syndrome, myelitis, and others). Results: we identified 268 patients for whom a diagnosis of MS had been given; after excluding misdiagnosed patients (33 Neuromyelitis optica), lost or incomplete records, 121 patients were included. The majority of patients(46.6%) were born in Lima. Female to male ratio was 1.37 to 1, mean age at diagnosis was 31 years. At onset, myelitis was present in 35% of RRMS patients, followed by brainstem syndrome (25%) and optic neuritis(18%). Brainstem syndrome was statistically significant predictor for earlier diagnosis (adjusted HR: 2.09; p = 0.015).Conclusion: