To assess if characteristics of patients presenting for suspected multiple sclerosis (MS) predict diagnosis, and the prevalence of missed prior symptoms in patients with MS.

MS diagnosis can be challenging, and diagnostic delay increases risk of disability. Few studies have comprehensively evaluated the characteristics of patients referred for suspected MS in a “real world” setting.

Retrospective review of demographic and clinical characteristics of new evaluations for MS with available MRIs from 2016 to 2024. Referrals for transfer of care and without available MRIs were excluded. T-test was used to compare continuous variables and chi-square for categorical variables. A univariate logistic regression examined the association between symptoms prompting presentation and MS, and comorbidities and MS.

1,408 patients were included. 305 (21.7%) had MS, 892 (63.4%) non-MS diagnoses, and diagnosis remained tentative for 210 (14.9%). 1,024 (72.7%) were female, and median age at presentation was 45.3 years. Most identified as White (1,321, 93.8%). Sensory symptoms were associated with higher odds of MS (OR=1.5, p=0.002). Presentation without symptoms was associated with lower odds of MS (OR=0.31, p<0.001). Absence of comorbidities increased the odds of MS (OR=2.69, p<0.001). Comorbid hypertension or migraine was associated with lower odds of MS (OR=0.58, p=0.002) and (OR=0.41, p<0.001). Fifty-three (17.4%) patients with MS reported additional, distinct neurologic symptoms occurring more than 12 months before their first MS evaluation – visual 22/53 (42%), sensory 16/53 (30%), and cerebellar 12/53 (23%) were most common. Additional data will be presented.

These large “real world” data suggest that referral for MRI abnormalities without symptoms, and that the presence of hypertension or migraine should prompt caution in the evaluation of patients for suspected MS. Missed earlier symptoms and opportunity for earlier diagnosis appear prevalent in patients with MS.