Could doctors of the future one day spot the signs of multiple sclerosis (MS) years earlier than they do now?
It’s an intriguing possibility raised by new research from the University of British Columbia, which suggests the disease’s earliest warning signs may materialize up to 15 years before the first classical neurological symptoms do.
“This is really important,” said senior author and UBC neurology Prof. Dr. Helen Tremlett.
“If you want to prevent MS from occurring at all, if you want to know what causes multiple sclerosis … we need to now make sure that we look much further back in time to avoid thinking that something causes MS when, in actual fact, the disease has already started.”
The study, published Tuesday in the journal JAMA Network Open, came to its conclusions by analyzing the health records of more than 12,000 British Columbians.
Researchers found that patients who developed MS actually began accessing health care at a higher rate than the general population a decade and a half before their classic MS symptoms appeared.
Researchers looked at doctor visits going 25 years before MS patients’ symptom onset, more than double the range that prior studies have examined.
Tremlett said the research suggests the existence of a “prodromal phase” to MS — a period during which non-specific signs and symptoms occur before the classical onset of disease.
“Historically, MS wasn’t thought to have a prodromal phase, which is a shame because other neurological conditions like Parkinson’s, this concept of a prodromal phase they’ve been studying since the 1980s,” she said.
“They can see that before the classical onset of Parkinson’s motor symptoms, maybe a decade or so before, they can pick up this prodromal phase. So I think it’s super exciting that we’re starting to realize this happens in multiple sclerosis as well.“
By studying the health records, Tremlett’s team found a steady build-up in contact with the health-care system leading up to patients’ MS diagnosis, with different types of doctor visits increasing at distinct points in time.
At 15 years before MS symptoms, they picked up a general increase in doctor’s visits, particularly related to symptoms like fatigue, pain, dizziness and mental health conditions like depression and anxiety.
At 12 years prior, they found an uptick in visits to a psychiatrist. Eight to nine years prior, visits to ophthalmologists and neurologists increased, potentially pointing to blurry vision or eye pain.
Visits to the emergency room and radiology increase three to five years before MS symptom onset.
And in the year before classic symptoms appeared, doctors’ visits across a slew of specialties picked up, including neurology, emergency medicine and radiology.
While that information gives researchers more threads to tug on, Tremlett stressed that these general symptoms cannot be used to diagnose MS, and that most people who experience them have nothing to worry about.
“It’s important for listeners to know that what we’re looking at here is patterns of health-care use in large groups of people,” she said.
“The vast majority of people who visit a doctor for the issues I mentioned do not, and will not, develop multiple sclerosis. So I do not want anyone to feel alarmed or concerned by our findings.”
However, she said the research suggests there is an opportunity in the future to recognize and potentially diagnose MS earlier, potentially through a biological marker in the blood, through family history or other combinations of clues that show someone to be in the disease’s prodromal phase.
Future research that achieves that goal, she said, could one day allow doctors to prevent or slow the disease’s progression over the long-term.
“What I’m painting here is a picture that could be achievable in the future,” she said.
“But we’re excited and we think that our findings kind of open that door to this new possibility.”