Early warning signs of multiple sclerosis may appear up to 15 years before symptoms emerge, new findings suggest
A large study indicates that people who will later develop multiple sclerosis (MS) begin using healthcare services long before their first MS symptoms appear, with patterns emerging as early as 14 to 15 years prior. The research adds to growing evidence that MS can begin with a protracted prodromal phase in which subtle, nonspecific issues arise well before a formal diagnosis.
MS occurs when the immune system attacks the protective coating around nerve fibers, leading to a range of possible symptoms that vary from person to person. Many individuals who later receive an MS diagnosis report vague early signals—such as persistent fatigue, anxiety, or depression—that can be mistaken for other conditions.
The study analyzed medical records spanning 25 years, comparing 2,038 people who developed MS with more than 10,000 individuals who did not. The groups were matched by age, sex, and place of residence to identify different patterns in healthcare use before MS onset. On average, those who would go on to develop MS were about 38 years old at symptom onset.
Key findings include:
– General or ill-defined symptoms led to increased doctor visits starting about 15 years before MS symptoms, with visits rising steadily and peaking in the year prior to onset.
– Mental health concerns, such as anxiety and depression, were more common in the 14 years before symptoms, and visits to psychiatrists began as early as 12 years before onset.
– Visits to neurologists and ophthalmologists increased in the final eight to nine years before symptoms appeared, with neurology visits in the year before onset more than five times higher for those who would develop MS than for those who would not.
Researchers emphasize that MS likely has a long and complex prodromal phase, during which underlying processes are at work without clear diagnostic signs. While early warning signs can be subtle and nonspecific, recognizing these patterns could open the door to earlier detection and intervention when disease-modifying therapies tend to be most effective.
What this could mean for patients and clinicians:
– Heightened awareness of long-range patterns could prompt closer monitoring of individuals who show persistent fatigue or mood-related concerns alongside vague physical symptoms.
– Earlier identification may enable sooner treatment decisions, potentially slowing disease progression and improving long-term outcomes.
– Primary care and neurology practices might consider integrating neurologic and psychiatric screening for patients presenting with persistent, unexplained symptoms, especially when accompanied by mood changes or fatigue.
Limitations and next steps:
– As an observational study, it cannot establish causation between early symptoms and MS development. Further research is needed to determine how best to translate these findings into screening tools or practice guidelines.
– Additional work is required to differentiate MS prodrome from other conditions with similar early signs and to identify specific, reliable indicators that predict MS risk.
A hopeful takeaway is that recognizing and understanding this extended prodromal phase could lead to earlier conversations between patients and clinicians, more timely referrals, and the possibility of starting therapies sooner to mitigate long-term impact. This line of inquiry reinforces the value of longitudinal health data in uncovering hidden patterns that precede serious diseases and could ultimately improve outcomes for people at risk of MS.