Dr. Helen Tremlett, professor of neurology at the University of British Columbia’s Faculty of Medicine, has been at the helm of the new study. This study has shed new light on the very beginnings of Multiple Sclerosis (MS). MS often begins much earlier than previously assumed, according to new research. A prodromal phase that can extend as much as 15 years prior to the appearance of the first classical neurological symptoms.
The research, released today in JAMA Network Open, compared public health records of more than 12,000 people enrolled in British Columbia’s universal health system. The researchers integrated clinical and administrative data from the province’s health system. This uniquely positioned them to capture the interval of physician visits in the 25 years preceding the first MS-related symptoms.
Indeed, Dr. Tremlett and her team have a long track record of laying the groundwork that defines the early stages of MS through past studies. Their preliminary results indicate that MS patients begin accessing healthcare resources significantly sooner. In fact, they start doing this at increased frequencies 15 years before succumbing to the characteristic symptoms.
This includes an almost 400 percent increase in visits to neurologists and ophthalmologists eight to nine years prior to symptom onset. There was an increase in use of emergency medicine and radiology three to five years before the appearance of symptoms. Most strikingly, we saw that visits to psychiatrists jumped 12 years before first MS symptoms were registered.
In the year prior to the development of symptoms, patients had the highest number of physician visits. This increase in visits especially strained the neurology, emergency medicine, and radiology specialties. This precedent means that millions of patients could be living with mild but notable symptoms for months or even years before they receive a clinical diagnosis.
Dr. Tremlett highlighted the challenges in recognizing MS early, stating, “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.”
Dr. Marta Ruiz-Algueró, the study’s first author, was funded by a Michael Smith Foundation for Health Research Trainee Award. In addition, she discussed her thoughts on what the implications of their findings are. She noted, “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.”
Our prepandemic study highlights the need for early recognition of such red flags as prognostic indicators for MS. Dr. Tremlett emphasized that “by identifying these earlier red flags, we may eventually be able to intervene sooner whether that’s through monitoring, support or preventive strategies.”
The study’s findings could pave the way for improved diagnostic processes and patient care strategies aimed at addressing MS in its earliest stages. Having a clearer understanding of the prodromal phase will help inform improved management strategies for individuals who are at increased risk of developing MS.
