Early MS Symptoms May Help Predict Diagnosis, Disease Course

Some prodromal symptoms of multiple sclerosis (MS) — symptoms that are evident before the disease begins in earnest — could help to predict the course of MS, a new study proposes.

In particular, its researchers suggest that MS patients with prodromal depression are more likely to be diagnosed with primary progressive disease (PPMS), while those with relapsing-remitting MS (RRMS) are more likely to experience digestive issues prior to the disease’s onset.

The study, “Do prodrome symptoms influence multiple sclerosis disease course and severity?,” was published in Medical Hypotheses.

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An accumulating body of evidence shows that many MS patients start to experience noticeable health changes years before they are diagnosed with the inflammatory neurological disorder.

For example, many experience early pain, emotional changes, or sleep problems. Understanding symptoms that might mark this early period, called the “prodromal period,” was recently highlighted as a research priority by the National MS Society.

A research team at the Lithuanian University of Health Sciences now proposed that some symptoms experienced during the prodromal period might be predictive of the future course of MS.

“Our central hypothesis states that emphasizing prodromal symptoms as early as possible might be a crucial factor in determining the course of the MS and predicting disability progression,” the scientists wrote.

As an initial test of this idea, the researchers surveyed 166 MS patients being seen at their university’s clinic. About two-thirds of these patients were female, and their average age was 43.

Many reported having prodromal symptoms. The most common, reported by 42.2% of patients, were heart-related issues such as changes in heart rate, unusually cold limbs, or changes in the color of mucus membranes — which line various cavities in the body that open to the outside world, like the nose, mouth, and respiratory and digestive systems — due to altered blood flow.

A similar proportion of patients reported early symptoms of pain or those affecting mental health, such as depression or anxiety. More than 1 in 3 participants also reported gastrointestinal prodromal symptoms, such as nausea or constipation.

These results broadly support previous reports showing that “prodromal symptoms might vary and manifest in many different forms and organ systems” in MS, the researchers wrote.

Statistical analyses indicated that prodromal depression was more common in patients who developed a primary progressive MS course. By comparison, early gastrointestinal symptoms such as nausea and bloating were more frequent in those initially diagnosed with RRMS.

“Patients with PPMS type were more affected by prodromal depression compared to the other groups,” the scientists wrote. “Early gastrointestinal symptoms … especially, nausea, vomiting and abdominal bloating manifested more frequently in [relapsing-remitting] type.”

People with prodromal anxiety or insomnia tended to have less severe MS, as assessed via the Multiple Sclerosis Severity Score (MSSS), the researchers noted.

“Patients who experienced anxiety and insomnia MSSS score median was lower in comparison with those who did not have these symptoms which might suggest their association with a milder course of MS,” the team wrote.

The scientists urged further research into connections between the MS prodrome and the disease’s later course.

“Finding significant connections between multiple sclerosis prodrome symptoms and course of disease as well as predicting disability level is a demanding task,” they wrote.