Global & Community Health: Diagnosis and Management of Multiple Sclerosis in Nepal: Overcoming Barriers Through Local Adaptations.

Abstract

Multiple sclerosis (MS) is the most common demyelinating disease of the CNS and disproportionately affects younger individuals, yet it remains underdiagnosed and undertreated in many low and middle-income countries. We describe key barriers to timely diagnosis and effective management of MS in Nepal, including limited public and clinician awareness; restricted access to neurologic care, MRI, and essential laboratory testing; and the high cost of long-term treatment. We also outline practical, context-specific adaptations such as simplified diagnostic pathways, use of affordable immunosuppressive therapies, and sustained advocacy by the Multiple Sclerosis Society of Nepal to improve access and affordability. Our experience illustrates pragmatic, low-cost strategies that may support more equitable MS care in resource-constrained settings.