Early Warning Signs For MS Discovered—Appear 15 Years Before Main Symptoms

Newsweek

6 days ago

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Warning signs for multiple sclerosis (MS) could emerge more than a decade before the first classical symptoms occur—offering hope for earlier detection and better patient outcomes.
This is the finding of researchers from the University of British Columbia (UBC), who have analyzed the health records of more than 12,000 people in the Canadian province and challenged assumptions about when the disease really begins.
They discovered those living with MS—a chronic condition affecting the brain and spinal cord—began using healthcare services at elevated rates 15 years before their first 'typical' MS symptoms appeared.
While MS affects people differently, symptoms often include feeling extremely tired, problems with your eyes or vision, numbness or a tingling feeling in different parts of the body, feeling off balance, muscle cramps and concentration/memory problems.
"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 paper author and UBC neurology professor Helen Tremlett in a statement.
"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."
Female doctor is taking the blood pressure of a young adult female patient during a medical consultation.
Female doctor is taking the blood pressure of a young adult female patient during a medical consultation.
Antonio_Diaz/Getty Images
The study offers a clear picture to date of how patients engage with a range of healthcare providers in the years leading up to a MS diagnosis as they search for answers to "ill-defined" medical challenges. Diagnosis for the condition typically requires imaging (MRI) signals and a specific clinical presentation.
The study tracked physician visits in the 25 years leading up to the onset of a patient's MS symptoms, as determined by a neurologist through detailed medical history and clinical assessments.
Most previous studies have only examined trends in the five to 10 years leading up to a patient's first "demyelinating event" (the loss or damage of the myelin sheath, a protective covering surrounding nerve fibers in the brain and spinal cord) such as vision problems.
Bruce Bebo, Executive Vice President of Research for the National Multiple Sclerosis Society, told Newsweek, "This is an impressive study by a world-class research team offering important new insights into the earliest manifestations of MS.
"The ability to identify people at high risk for MS could trigger enhanced monitoring and subsequent identification of people in the earliest stage of disease. Treatment of MS at this earliest stage would likely result in significantly improved outcomes."
The researchers revealed that, compared to the general population, people with MS had a steady build-up of healthcare engagement over 15 years with different types of doctor visits increasing at particular points.
Some 15 years before symptom onset, patient visits to general practice physicians increased, as did visits to any physician for symptoms like fatigue, pain, dizziness and mental health conditions. At 12 years before, visits to a psychiatrist increased.
Three to five years before diagnosis, emergency medicine and radiology visits increased. And one year before, physician visits across multiple specialties peaked, including neurology, emergency medicine and radiology.
"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 paper author and UBC postdoctoral fellow Marta Ruiz-Algueró in a statement.
"We're only now starting to understand what these early warning signs are, with mental health-related issues appearing to be among the earliest indicators."
The study follows previous work by Tremlett and her team to characterize the early stages of MS, known as the 'prodromal phase', where subtle signs or other symptoms occur before the onset of more typical symptoms.
These periods are well established in other neurological disorders like Parkinson's disease, where mood changes, sleep disturbances and constipation often arise years before the more familiar motor symptoms like tremors and stiffness.
While the researchers point out the vast majority of people who experience general symptoms like fatigue and headaches won't go on to develop MS, they say recognizing and characterising the MS prodrome could one day help accelerate diagnosis and improve outcomes for patients.
"By identifying these earlier red flags, we may eventually be able to intervene sooner—whether that's through monitoring, support or preventive strategies," said Dr. Tremlett. "It opens new avenues for research into early biomarkers, lifestyle factors and other potential triggers that may be at play during this previously overlooked phase of the disease."
Could we use these early signs to reduce risk of MS developing? Bebo said: "It is likely that the central nervous system is already affected at this early stage of the disease, making true prevention unlikely. However, initiating treatment with a disease-modifying therapy at this point could halt disease progression."
However, he added, "Many consider the onset of MS begins when autoreactive immune cells gain access to the central nervous system and start causing damage.
"If we can identify the very earliest changes in the immune system prior to entry into the central nervous system and prevent these cells from getting access to the brain and spinal cord, it might be possible to prevent MS."
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Reference
Ruiz-Algueró, M., Zhu, F., Chertcoff, A., Zhao, Y., Marrie, R. A., & Tremlett, H. (2025). Health Care Use Before Multiple Sclerosis Symptom Onset. JAMA Network Open, 8(8). https://doi.org/10.1001/jamanetworkopen.2025.24635