Early signs of MS may appear years before a diagnosis
Disease may begin earlier than recognized, indicators being mental health issues
People who develop multiple sclerosis (MS) begin using healthcare services more frequently up to 15 years before their first MS symptoms appear, a study from the University of British Columbia (UBC) suggests.
The findings add to evidence that early signs of MS may go unnoticed for many years. Detecting these warning signs could aid an earlier diagnosis and start of treatment, when it’s likely to be most effective.
“Our findings dramatically shift the timeline for when these early warning signs are thought to begin, potentially opening the door to opportunities for earlier detection and intervention,” Helen Tremlett, PhD, a professor of neurology at UBC and study leader, said in a university press release. The study, “Health Care Use Before Multiple Sclerosis Symptom Onset,” was published in JAMA Network Open.
MS occurs when the immune system mistakenly attacks the protective myelin sheath on nerve fibers, causing a range of symptoms. While not all patients experience MS in the same way, many first notice vague symptoms such as excessive fatigue, anxiety, and depression years before a diagnosis is made.
“MS can be difficult to recognize as many of the earliest signs — like fatigue, headache, pain and mental health concerns — can be quite general and easily mistaken for other conditions,” said Tremlett, who’s also a researcher at the Djavad Mowafaghian Centre for Brain Health in Canada.
Increasing use of healthcare services
While it’s known that people who develop MS begin using healthcare services more before their first symptoms appear, most studies have focused on the five to 10 years before the onset of overt MS symptoms. Tremlett’s team looked at data stretching back 25 years, drawing on medical records from 2,038 people with MS whose healthcare use was compared to that of more than 10,000 people without MS. The groups were matched by age, sex, and where they lived, the goal being to see if those who later developed MS had used healthcare services differently.
The patients were an average age of 37.9 at the time of the onset of their MS symptoms, and they visited a doctor more often starting 14 years before their symptoms began. These visits increased steadily, reaching their highest point in the year before the onset of symptoms.
Visits for general or “ill-defined” symptoms — for example, fatigue, dizziness, or feeling unwell without a clear diagnosis — were more common starting 15 years before the onset of symptoms. Visits related to mental health problems such as anxiety and depression were more frequent in the 14 years before symptoms, and visits to psychiatrists began as early as 12 years before.
“These patterns suggest that MS has a long and complex prodromal phase — where something is happening beneath the surface, but hasn’t yet declared itself as MS,” said Marta Ruiz-Algueró, PhD, a postdoctoral fellow at UBC and the study’s first author.
Visits to neurologists and ophthalmologists became more frequent in the last eight to nine years. In the year before symptoms appeared, neurologist visits were more than five times as high for people who went on to develop MS compared with those who didn’t.
“These findings suggest that MS may begin much earlier than previously recognized, with mental health-related issues as early indicators, highlighting opportunities for earlier identification and intervention,” the researchers wrote.
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