Higher Rates of Mental Health and Gastrointestinal Issues in the MS Prodrome

Summary: Dr. Helen Tremlett (University of British Columbia) and team have identified and described a multiple sclerosis (MS) prodromal period – a range of non-specific signs or health conditions that occur at least five years before the clinical diagnosis of MS. Recent findings from Dr. Tremlett’s team found that people with MS showed high rates of health service use for mental health conditions and gastrointestinal issues in the five years before MS diagnosis. These conditions pose a significant burden very early in the MS disease course and may be part of the MS prodrome. 

Background: A prodrome refers to a range of non-specific signs or health conditions that occur years before the clinical diagnosis of a disease. Dr. Helen Tremlett and team have identified and described a MS prodromal period for at least five years prior to MS symptom onset. Prior studies from Dr. Tremlett have shown that in this prodromal period, people with MS have higher rates of hospital and physician visits, an increase in prescription drugs, and experience a number of non-specific health issues (i.e. pain, sleep disorders, anaemia, fatigue, mood and anxiety disorders, and migraines). 

Details: The research team aimed to further define the clinical characteristics of the MS prodrome. Health administrative and clinical data of over 7,800 individuals with MS and 36,000 individuals without MS from British Columbia, Canada were used to identify health conditions that may occur during the MS prodromal period (five years before the first demyelinating event or MS symptom onset).

Results: The research team found that individuals who were diagnosed with MS showed higher rates of health service use for mental health conditions 1 (e.g., depression, anxiety, bipolar disorder or schizophrenia) and gastrointestinal issues2 (e.g., gastritis and duodenitis, diseases of the esophagus, constipation, irritable bowel syndrome) in the five years before MS diagnosis. The increased use of health services included physician visits, hospital admissions, and prescriptions particularly for gastrointestinal-related drugs, including constipation and gastroesophageal reflux disease. 

Impact: These findings suggest that mental health and gastrointestinal conditions pose a significant burden very early in the MS disease course and may be part of the MS prodrome. A better characterization of the MS prodrome and what signs and symptoms increase one's risk of MS may allow for more timely recognition of individuals in this phase, and potential for earlier diagnosis and treatment to prevent symptom onset and disability progression. Since current health issues associated with the prodrome can be common in the general population, additional studies and markers of the prodrome are required to understand those who are truly at risk of MS.

Reference:

Articles published in:

  1. Neurology on September 25, 2023 – Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis. Link to article – here.  
  2. Annals of Clinical and Translational Neurology on December 19, 2023 –  Gastrointestinal Conditions in the Multiple Sclerosis Prodrome. Link to article – here.