During a roundtable discussion, an international panel of experts chaired by Professor Jorge Correale from the University of Buenos Aires discusses the challenges in diagnosing and treating MS in low-income countries.
Dr Maria Zuluaga, Neurology leader Medical MS Clinic in Medellin Colombia and Dr Shanthi Viswanathan, head of the department of Neurology and clinical director of the Neuroimmunology Unit at the Kuala Lumpur Hospital in Malaysia share insightful and well-documented real-world perspectives on Southeast Asia and Colombia.
Dr Viswanathan focuses on Southeast Asia (SEA) and highlights that, according to the Atlas of MS 2020-2024, 83% of countries globally face at least one barrier in early MS diagnosis. Most of these barriers are experienced in lower income countries. A recent cross-sectional study from SEA found that all the 11 countries of SEA (9% of world population) report barriers in early diagnosing MS and accessing treatment, including lack of epidemiological data, insufficient technological resources, a lack of education, research, and lack of awareness about the latest MS drugs [1]. Most of these countries have lower middle/lower income. The study also points out the limited number of neurologists relative to the population (most SEA countries have less that 1 or 2 neurologists per 105 inhabitants). The treatment guidelines for MS are only available in 3 out of 11 countries.
Dr Viswanathan points out that MS is a neglected, non-communicable disease SEA and “this is due to a lack of population based epidemiological data, that creates a blind spot regionally obscuring the true burden of MS” [2]. Individuals with MS struggle for resources and funding. Therefore, a change is needed at a systemic level. These countries would need research funding and international support for publications. MS prevalence is increasing in SEA. Delays in diagnosis can also be caused by unique disease related factors and atypical MS presentations. Furthermore, some disease – like tuberculosis or dengue encephalitis – can mimic MS leading to misdiagnosis [3].
High-efficacy treatments are only accessible in 3 countries out of 11. Centers of excellence for MS treatment should be created in resource-limited settings and specialised training should be offered to the neurologists.
Dr Zuluaga focuses on the challenges behind diagnosing and treating MS in Colombia, where both MS prevalence and incidence are increasing. Two and a half years is the time that can take in Colombia to be diagnosed with MS from symptoms onset. Dr Zuluaga points out that healthcare providers have less familiarity with MS in Colombia, they have a limited training in neurimmunology and there are only a few specialised MS centers offering diagnostic services.
Dr Zuluaga highlights the high cost of treatment for a relatively uncommon disease in Colombia. Patients can find neurologists mostly in specialised centers concentrated in the main cities and this implies high travel costs for individuals leaving in rural areas.
Collaborative efforts worldwide between healthcare professionals, policymakers, and patient organisations are essential to ensure equitable access to MS care.
References
[1] Viswanathan S et al. Mult. Scler. and Relat. Disord. 2024; 85: 105555.
[2] Cheong WL et al. Front. Neurol. 2018; 9: 432.
[3] Correale J et al. Lancet Neurol. 2024; 23.10: 1035-1049.