August 8, 2018

Evidence of non-MS related health issues in the five years leading up to first MS-related symptom

Background: Non-specific health symptoms or signs prior to the onset of the disease is called a prodrome. Characteristics of an MS prodrome are unknown.

Canada has one of the highest rates of Multiple Sclerosis (MS), yet the cause of MS is incompletely understood. Researchers are invested in identifying the underlying cause of MS and have found that multiple factors are involved including genetic and environmental factors. The idea that environmental factors may contribute to MS suggests that MS may take years to develop prior to the manifestation of the disease. Early non-specific signs and symptoms occurring years prior to confirmed clinical diagnosis is called the prodrome. Prodromes have been identified for neurodegenerative diseases such as Alzheimer’s and Parkinson’s and provided insight into the causes of the disease as well as stimulated new research. To date, there is limited research suggesting that an MS prodrome exists.

A study conducted by MS-Society-funded researchers, including Helen Tremlett, from the University of British Columbia, ventured to identify the clinical characteristics of the MS prodrome. Their research was recently published in the Multiple Sclerosis Journal.

The Study: Health administrative and clinical data were analyzed to identify characteristics of an MS prodrome

Health administrative and clinical data, from approximately 17,000 individuals with MS and 83,000 individuals without MS, was reviewed from four Canadian provinces (British Columbia, Saskatchewan, Manitoba and Nova Scotia) to determine if there are any health issues in people that are later diagnosed with MS.

Results: An increase in a variety of health issues leading up to the first MS symptom were identified.

The researchers found that in the five years leading to MS-related symptoms, individuals that were eventually diagnosed with MS were up to four times more likely to visit the hospital or physician with nervous system related concerns and 50 percent more likely to visit a psychiatrist compared to those without an MS diagnosis. Furthermore, there were higher rates of health system use for conditions related to the sensory organs, musculoskeletal system, genito-urinary system, and skin-related disease in individuals that were later diagnosed with MS. Of note, migraine headaches and mood or anxiety disorders such as depression and anxiety were also high among people to be diagnosed with MS.


There is a limited number of studies that have provided insight into whether an MS prodrome exists and what it constitutes. This study assimilates the health-care records from four different provinces to provides support for and identify characteristics of an MS prodrome. These results set the foundation for future research including specific questions such as: Is there the presence of certain biomarkers that could be used to identify this asymptomatic stage? Are there therapies that could further delay MS diagnosis that can be taken in the prodrome stage? Are there health patterns related to sex or age in the MS prodrome?

The health characteristics of an MS prodrome could provide an opportunity for the identification of an earlier time window when the disease is active and potentially provide treatments to prevent the MS onset.


Wijnands J et al. (2018) Five years before multiple sclerosis onset: Phenotyping the prodrome. Mult Scler. [Epub ahead of print]