Delayed diagnosis of multiple sclerosis in males: may account for and dispel common understandings of different MS ‘types’

Abi Eccles

doi:10.3399/bjgp19X701729

INTRODUCTION

Multiple sclerosis (MS) is a long-term neurodegenerative condition that affects functioning of the central nervous system, and estimates of its prevalence range from 1–2.5 million people diagnosed worldwide.¹^,² Just as the central nervous system mediates a breadth of bodily functions, MS can manifest in varied ways, often leading to confusion as to whether ill-health is caused by MS or something else.

MS trajectories vary between individuals, and different MS ‘types’ are commonly used to describe patterns. Relapsing remitting MS (RRMS) refers to short-term exacerbations (relapses) and recovery (remission); secondary progressive MS (SPMS) develops after RRMS and describes long-term permanent neurodegeneration. Primary progressive MS (PPMS) also refers to long-term permanent neurodegeneration, but without a relapsing remitting stage preceding it.³

LIMITED CONCEPTUALISATIONS AND EXPLANATIONS

Although these different MS ‘types’ are commonly referred to within professional and lay circles, individuals’ trajectories do not always fit comfortably into their descriptions,⁴ no biomarkers have been identified to distinguish between them,⁵ and they are not recognised as subtypes in the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).⁶

Internationally MS appears to be more prevalent in females than males¹^,⁷ and the difference in ratio seems to be rising,⁸ except in the case of PPMS, where those diagnosed are more likely to be male and older.⁹ Previous research indicates no clear cause for apparent sex …

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