These Are the Worldwide Barriers to Multiple Sclerosis Diagnosis and Treatment

Pervasive, consistent barriers to receiving an early multiple sclerosis diagnosis exist worldwide, which reflects a lack of resources in many countries.

One of the most significant worldwide barriers to treating multiple sclerosis (MS) is early recognition of symptoms by patients and the lack of clinician availability to diagnose, according to study findings published in Neurology

An early recognition and diagnosis of MS can improve the associated health care costs and the disability-adjusted life years. However, there are significant diagnostic delays despite extensive resources and registries worldwide.

Researchers conducted a cross-sectional study to assess the global data surrounding MS diagnosis from the Multiple Sclerosis International Federation (MSIF) third edition of the Atlas of MS survey. The Atlas questionnaire assessed patient state of diagnosis, diagnosis barriers, and respective national guidelines where the patient was located. 

This survey was distributed to health care professionals through the MSIF network of MS organizations. Surveys were collected from October 2019 through April 2020 through an online survey tool. Coordinators from 107 countries (approximately 82% of the world) assisted with the Atlas survey distribution.

Barriers to timely MS diagnosis reflected a lack of resources in many countries.

Regarding MS diagnostic criteria, 36 countries reported only using the 2017 ​​McDonald criteria (McD-C) and 84 (79%) countries overall used this criterion. In particular, countries considered high and upper middle-income were more likely (n=31 [42%]) to use this criterion, compared with lower middle- or lower-income countries (n=5 [16%]). 

There were 88 countries that reported at least 1 barrier to early MS diagnosis, including lack of awareness of MS symptoms among patients (n=72 [68%]) and lack of availability of health care professionals qualified to diagnose MS (n=47 [44%]). 

Lower middle- and low-income countries reported barriers to preventing early MS more frequently than high and upper middle-income countries (31 [94%] vs. 57 [78%], P =.05). 

There were 66 countries that reported at least 1 barrier to adopting the 2017 McD-C, with a majority reporting that neurologists lack awareness or training (n=45 [45%]). 

Regions part of the European or Eastern Mediterranean regions were less likely to report barriers to implementing 2017 McD-C compared with other regions, such as Africa (13 [87%]), America (13 [76%]), Western Pacific (7 [78%]), South East Asia (5 [83%]) (P <.001).

Around less than half (49%) of countries had established national guidelines for MS diagnosis. Countries that were considered high or upper-middle class were more likely to have national MS diagnosis guidelines, compared with those who were lower middle- or low-income countries (45 [63%] vs 6 [18%]; P <.001). 

A total of 43 countries had national standards for MS care, 24 of which had a standard for the speed at which a patient is diagnosed. Countries that only used 2017 McD-C had a lower chance of reporting national standards (odds ratio [OR], 0.23; 95% CI, 0.07-0.68).

“Barriers to timely MS diagnosis reflected a lack of resources in many countries,” the researchers wrote. “This most often included a lack of healthcare professionals, including neurologists and subspecialty MS neurologists in particular, and medical equipment or diagnostic tests such as MRI machines, and other laboratory equipment, particularly in lower-income settings.”

Study limitations included relying solely on expert opinion, underrepresentation from African regions and countries, and the inability to draw conclusions regarding the accuracy of MS diagnosis. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Solomon AJ, Marrie RA, Viswanathan S, et al. Global barriers to the diagnosis of multiple sclerosis: data from the multiple sclerosis international federation atlas of MS, Third Edition. Neurology. June 15 2023. doi:10.1212/WNL.0000000000207481