Subtle signs of multiple sclerosis may appear years before onset

Medical News Today

13 hours ago

Research is ongoing regarding when multiple sclerosis develops and strategies for prompt diagnosis. A recent study found that people who went on to develop multiple sclerosis had a much higher use of medical services up to 15 years prior to multiple sclerosis onset. The results suggest that multiple sclerosis develops earlier than researchers thought in the past, and could help with earlier management of the condition. According to the National Institute of Neurological Disorders and Stroke, 'multiple sclerosis (MS) is a chronic neurological disorder.' There are multiple types, and people can experience symptoms like cognitive changes, vision changes, and even paralysis. A study recently published in JAMA Network Open looked at the use of healthcare services in the 25 years before MS symptom onset.Compared to a matched cohort of participants without MS, participants with this condition used healthcare services more than their peers in the 15 years before MS onset.Researchers were able to identify specific visit reasons in certain timeframes, with mental health concerns and ill-defined signs and symptoms being some of the earliest problems.The results suggest that MS starts earlier, which may help with diagnosis and early intervention for the condition. What does medical treatment look like before MS diagnosis?For this research, experts wanted to learn more about the prodromal phase that may happen in MS, particularly looking at even earlier data than what has been previously studied. The study was conducted in British Columbia, Canada, and researchers used insurance data. They looked at hospital and doctor visits. They used the British Columbia MS clinical database to learn when participants first had MS symptoms. Researchers also had access to data on filled prescriptions and population data. Researchers were able to look at data from 2,038 participants with MS, as well as a matched cohort of 10,182 participants who did not have MS. After looking at the doctor visit rates each year in the 25 years prior to MS onset, researchers honed in on the 15 years before. This was when changes in health care visits started.In the 15 years before MS onset, researchers identified more visits from MS participants for ill-defined signs and symptoms. In the 14 years before MS onset, researchers identified an increase in doctor visits, doctor visits related to mental health, and injury-related visits. The elevation in mental health visits was significant for most of the 14 years prior to MS onset, with the exception of years 7, 5, and 4. Overall, mental health visits were up 76%. Twelve years before MS onset, there started to be an increase in psychiatric visits, and this remained significant except in years 6 to 8, and year 4 before MS onset. Overall, the increase in psychiatric consultations was 159%. Increase in ophtalmology, nervous system-related doctor's appointmentsOphthalmology visits were increased 9 years before MS onset, except at year 6 and year 2, with the highest increase the year right before MS onset. In the 8 years before MS continued to be high prior to MS onset except at year 7 and year 5. The greatest spike was in the year right before MS onset. Visits for musculoskeletal-related problems were increased in the five years before MS onset.At year four and in the year leading up to MS onset, there was also an increase in visits for nervous system conditions, with a greater increase in the year before MS onset. Visits to the emergency room were greater 5 years before MS onset, radiology increased 3 years before, and internal medicine and neurosurgery increased one year before. Many healthcare visit upticks peaked in the year right before MS onset. For example, doctor visits and visits for injury, ill-defined signs and symptoms, sensory-organ concerns, and musculoskeletal-related problems peaked in the year before MS onset. Other types of visits were affected in specific years. For example, endocrine visits increased in year 9 prior to the onset of MS. At the same time, visits related to pregnancy and childbirth decreased to a significant level in years 2 and 5.Certain conditions also had distinct increases prior to MS onset. For example, researchers observed increases in anxiety and depression at years 4, 3 and 2. In the 2 years before MS onset, there was an increase in problems like dizziness and vertigo.In the year before MS onset, there was an increase in migraines and specific eye problems, such as retinal detachment. This data supports the idea that MS may start much sooner than experts previously believed and indicates the need for more research. The authors suggest that psychiatric and mental health concerns may be early features of the prodromal phase of MS, because these concerns started years before increases in visits related to the nervous system. Risk of MS overdiagnosis?While this research did allow for extensive follow-up, there are still limitations. First of all, researchers did not have data on some clinical information details. Instead, they had information on why participants sought out health care services. Second, there is some risk for misclassification or miscoding based on the data researchers used. There are also challenges of determining MS symptom onset, and researchers note that this 'may be influenced by recall bias and challenges with medical history taking.' Some participants had a claim for a demyelinating event or MS before the date designated as the 'MS symptom onset date.'It is possible there were some cases of MS that doctors could have diagnosed earlier. It's also possible that participants in the matched cohort had MS, in spite of evidence against this. This data focused on people with MS in British Columbia, Canada, and the majority of participants with MS were female, limiting generalizability.Further, researchers did not collect data on race or ethnicity, so more data specifying this could be helpful. They only corrected for some factors in the statistical analysis, which could have impacted the results. Burcu Zeydan, MD, an assistant professor of neurology at Mayo Clinic, who was not involved in this research noted the following cautions to Medical News Today: 'We see that healthcare visits in the 'pre-MS diagnosis' period are mainly for rather nonspecific and/or common causes such as headaches, fatigue, and mental health issues. Since most of these individuals will never develop MS, identification of individuals in a possible MS prodrome carries the risk for overdiagnosis and overtreatment as well as a concern for causing unnecessary distress for individuals and families. There is also a possibility of missed opportunities for earlier recognition of MS by clinicians, which is supported by the rise in ophthalmology and neurology visits in the current study as pointed out by the authors. These should be considered in evaluating the MS prodrome.''MS may start earlier than previously thought'The research implies that MS starts earlier and delves into deeper questions about what may cause the condition. Study author Professor Helen Tremlett, PhD, in the Faculty of Medicine (Neurology) at the University of British Columbia, Canada, explained to MNT that:'MS may start earlier than we previously thought, and that is actually really important when we think about what causes MS… Our findings suggest we need to look back much further in time than we do, perhaps currently, to avoid thinking that something might cause MS, when, in actual fact, the disease has already started… There's potential here in the future, not currently, to recognize and perhaps diagnose and manage MS earlier than we can do currently, with the view of course of preventing or slowing progression of the disease.'Zeydan noted that, 'using the observations related to MS prodrome, [researchers] should aim to develop individual-level risk models, possibly a scoring system to reliably identify individuals that are at high risk for developing MS.''Biomarkers (blood and imaging) would be the key to this effort,' she told us. 'Perhaps age and sex differences and tools such as AI can help finetune MS risk prediction models,' Zeydan further hypothesized.'With a potential future multimodal biomarker panel, if people at high risk can be effectively identified in the MS prodrome, individualized disease screening methods can be implemented into MS care for these high-risk individuals,' she concluded.