A Survey of Diagnostic and Treatment Practices for Multiple Sclerosis in Türkiye

Abstract

Introduction: Multiple Sclerosis (MS) is a dynamic therapeutic field, with diagnosis and treatment processes changing over time. In recent years, developments for individualized diagnosis and treatment have been ongoing. The aim of this study is to understand the management practices used by neurologists working in the diagnosis, follow-up and treatment of multiple sclerosis in Turkey. Materials and methods: A questionnaire form was prepared in which participants could participate online. Multiple-choice or consent questions were asked about the diagnosis of MS, the choice of radiologic and laboratory tests used, and treatment management. The findings were evaluated in terms of minimum, maximum, mean +/- standard deviation and percentile. In addition, the parameters of MS specialists such as years of experience and years of education were compared. Results: A total of 109 participants were included in the study. The duration of neurology specialization ranged from 2 to 41 years, with a mean of 17.9 years. 70.4 % of the participants were members of the Turkish Neurological Society MS Study Group. In terms of MS education, 92.7 % of the participants stated that the education they received was adequate, while this rate was 71.6 % for differential diagnosis. The rate of lumbar puncture in all patients at the diagnostic stage was 77.1 %. For the diagnosis of MS, 35.8 % of the participants stated that NMO and MOG tests were performed in all patients. When the frequency of requesting MRI during the follow-up phase was questioned, 61.5 % of them were once a year. The most common approach for radiologically isolated syndrome (RIS) patient management was to recommend initiation of DMT for follow-up and if activation persisted on MRI six months later. The first choice of DMT in early stage MS patients was initiation of dimethyl fumarate with 56.9 %. 74.3 % of the participants stated that they would never recommend discontinuation of treatment in MS. Conclusion: It was observed that specialists practicing MS in Turkey generally received adequate training, were more competent in radiologic evaluation, and the majority preferred dimethyl fumarate in naive patients. In patients with radiologically isolated syndromes, radiologic activation was observed as an indication to start treatment.