Behind the Headlines: Could we spot MS more than a decade before diagnosis?

A new study from Canada has shown people start using more healthcare many years before being diagnosed with MS. But we’ve known for some time that in the years leading up to an MS diagnosis, people often see their GP more and have more recorded health issues.  

And it doesn’t mean doctors can currently tell if someone is going to go on to be diagnosed with MS from their healthcare visits 15 years earlier. Most people who see their GP for things like their mental health won't go on to develop MS.  

Read the full paper on the journal website 

What is the MS prodrome? 

Over the last decade, several studies have described a possible ‘prodromal stage’ of MS. This is the very early stage of the condition before the more typical symptoms appear.  

Previous studies have shown people with MS use healthcare services like GPs more than people without MS up to ten years before diagnosis. And this happens more as you get closer to diagnosis.  

In these studies, the reasons for the early health visits were varied, ranging from bladder and bowel symptoms to migraines to mental ill-health.  

The prodrome isn’t unique to MS. Scientists study it in many conditions, such as Parkinson’s Disease and rheumatoid arthritis. 

What did the new study do? 

The researchers looked at medical records for over 2,000 people with MS and more than 10,000 people without MS. They studied GP and specialist visits going back 25 years before the first MS symptoms appeared. 

Unlike previous studies, they used doctors’ clinical notes to identify the date they believe someone first had MS symptoms, as well as administrative data.  

Administrative data is information collected for paperwork and statistics. For example, a hospital record might have a diagnosis code showing someone was treated for optic neuritis. But this may not show the full picture of when eye symptoms began. 

What did the new study find? 

They confirmed the same pattern seen in earlier studies: more healthcare use before diagnosis. But they found it may begin even earlier than we thought, up to 15 years. 

Some of the earliest differences were: 

• More visits to GPs for general symptoms doctors couldn’t easily explain, like pain, fatigue, or dizziness 

• More visits for mental health and, slightly later, support from psychiatrists 

This happened before healthcare visits were more clearly related to issues with the brain and spinal cord. And visits to neurologists or eye specialists increased.  

What does this mean for people with MS? 

This study provides valuable information to help us better understand the MS prodrome. Understanding what’s happening in the brain and spinal cord during this early period could ultimately help to: 

• diagnose MS earlier, so people can start treatment and support sooner
• reveal new ways to slow or even stop MS before more damage is done
• test new treatments earlier, which might work best before the condition has fully developed
• understand how the condition develops, giving clues to what triggers it and ways to prevent people developing MS in the first place.

What do we still need to know?

The study used records from one part of Canada, so we don’t know for sure whether results would look the same in the UK. It also looked at patterns across large groups of people, rather than at predicting MS in an individual. And we still don’t know which specific combinations of symptoms are the most reliable early clues. So more research is needed.