Why is MS diagnosed late in Black patients With Dr. Mitzi Joi Williams (Video)

Dr. Mitzi Joi Williams is a top neurologist and Multiple Sclerosis (MS) Specialist in Atlanta, Georgia. She received her undergraduate degree in Neuroscience and Behavioral Biology from Emory University and her Doctor of Medicine degree from Morehouse School of Medicine. Dr. Williams completed her internship and residency in neurology as well as a Clinical Fellowship in Multiple Sclerosis at the Medical College of Georgia in Augusta, GA. Dr. Williams has a strong interest in understanding and furthering research in MS in ethnic minority populations. She is a sought-after speaker and presenter and has discussed her research both nationally and internationally at various scientific meetings. She has spearheaded and participated in multiple Steering Committees and Work Groups to further research in underserved population with MS. She also has recently increased involvement in efforts to increase diversity in clinical research and educate the community about the importance of research participation. Dr. Williams is the author of MS Made Simple: The Essential Guide to Understanding Your Multiple Sclerosis Diagnosis. Because of her passion for teaching and advocacy.

Black patients can be diagnosed with multiple sclerosis later for a variety of reasons. Again, sometimes those first symptoms may come on and go away and so you may not think anything of it. I've had many people that have come to see me and when I had my last child, I had a little bit of numbness in my leg. I thought it wasn't anything. It went away and I never went to the doctor. And that may have been that first symptom of multiple sclerosis. And if the next symptom doesn't happen until five or six years later, that can delay diagnosis when we should have hopefully caught it as early as possible. Another reason is that sometimes there's bias within the medical system. So traditionally we did not think that African Americans got MS so when an African American would come to see the doctor and had those symptoms, MS may not have been on the top of their list.

Also, traditionally there have been issues with access to care, especially MRIs. Even when I first started training, which wasn't that long ago, I remember it was very difficult to get an MRI on somebody as an outpatient, so if someone came to my clinic and their hand or arm was a little numb, it was very difficult to get an MRI for that, so we may have diagnosed it as something else and then later found out that it was multiple sclerosis, but now that we have more access, we're able to diagnose people earlier. So access to care is certainly an issue. Also bias within the system and then certainly ignoring symptoms or attributing them to something else is one reason that people may be diagnosed later.

Is MS more aggressive in black patients?

There is a body of research over the past 10 years that suggests that MS is more aggressive in African Americans. There are several studies that have looked at MRIs that show that African Americans tend to have more white spots on their MRIs in their brain. They also tend to have more involvement of the spinal cord. The spinal cord is an area that I call expensive real estate and essentially what that means is that there's a lot of function packed into a very small area.

So if you have lesions in your brain, you can have several spots there and it really not affect your overall function, but a very small area affected in the spinal cord could significantly affect someone's ability to walk, their ability to feel and also things like their bowel or bladder function. So there tends to be more spinal cord involvement which leads to more disability.

There are also several studies that suggested that African Americans may need to use a cane or a walker or even a wheelchair up to 10 years faster than their Caucasian counterparts and that also there is more disability overall in the African American population. One of the difficulties with the research that's been done so far is that all of it is what we call retrospective. That means we take a group of people where they are right now and we look at how they did over time. It really doesn't factor in other things like access to care, access to insurance, or different difficulties where people may have missed their medicine or been diagnosed later.

One better way to do research or to gather information is to do what we call prospective research, where we start everybody out at ground zero and we see how they did moving forward. Even though we see that African Americans do tend to have more aggressive disease from the research that we've seen, we really don't know the role of access to care and access to insurance and how those social determinants of health really play into the worst outcomes that we see.

Wednesday, August 21st, 2019

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