This study aimed to identify key challenges in diagnosing MS in Nepal, evaluate access to disease-modifying therapies (DMTs), and propose strategies for MS management in resource-limited settings.

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. Early diagnosis and treatment are critical for managing MS, but in low-resource settings like Nepal, the lack of healthcare infrastructure creates significant barriers.

From January to July 2023, surveys were conducted in four community health centers and six tertiary hospitals across Nepal. Fifteen healthcare professionals and 40 MS patients were interviewed about diagnostic delays, treatment barriers, and access to DMTs. Medical records from 2018–2023 were also analyzed.

The study identified several key barriers to MS diagnosis and treatment in Nepal. Only 35% of healthcare providers could accurately diagnose MS using clinical criteria and MRI, while the rest relied on incomplete neurological assessments. Patients experienced an average diagnostic delay of 2.5 years post-symptom onset, with 28% receiving an initial misdiagnosis (Table 1). Major contributing factor was the lack of access to advanced imaging facilities; with only 4 out of 10 hospitals surveyed having an MRI machine. Moreover, 70% of hospitals lacked trained neurologists, leaving physicians to manage complex cases. In terms of management, 60% of patients reported irregular access to DMTs, primarily due to high costs and inconsistent drug supply (Table 2).

Table 1: Common Misdiagnosis of MS     

Table 2: Barriers to Accessing DMTs

Addressing infrastructural and economic challenges is crucial for improving MS care in Nepal, with an emphasis on reducing diagnostic delays and increasing access to affordable treatments.