A wide-ranging new study suggests that maybe we’ve got the multiple sclerosis (MS) timeline all wrong.
A group of Canadian researchers has combed through decades of clinical and administrative health data and discovered that subtle symptoms and increasing healthcare utilization crop up as soon as 14 to 15 years before a patient receives an official MS diagnosis.
Appearing in JAMA Network Open, the researchers tracked more than 12,000 individuals in British Columbia, comparing 2,038 people later diagnosed with MS against a matched cohort of 10,182 who never received a diagnosis.
By examining physician visits up to 25 years before the emergence of symptoms, the researchers wanted to understand whether health care patterns could hint at the onset of MS.
Early Warning Signs
The headline? Visits driven by mental health issues jumped dramatically about 14 years before MS symptom onset. That data revealed that participants who would later develop MS were 76% more likely to seek out mental health care during that time.
In fact, psychiatric consultations shot up 159% as early as 12 years before onset. Conditions such as anxiety, depression, dizziness, and insomnia all drove higher visit rates well before the appearance of neurological symptoms.
Overall, individuals who later developed MS boasted higher physician visit rates beginning 14 years before their first symptoms. These visits peaked in the year immediately preceding onset and remained consistently higher for general practice, psychiatry, neurology, and ophthalmology visits.
- General practitioners saw a 23% increase in visits from future MS patients across all 15 years leading up to diagnosis.
- Visits to neurologists and ophthalmologists rose between eight and nine years before symptom onset. Neurology visits specifically skyrocketed, showing a more than fivefold increase in the year just before diagnosis.
- Emergency room visits and radiology consults also jumped in the three to five years before MS onset, which could hint at attempts to explain or diagnose emerging but vague symptoms.
From Ill-Defined Symptoms to Much Worse
The types of symptoms that patients reported also evolved. Fifteen years before symptom onset, patients began presenting with what the researchers dubbed “ill-defined symptoms and signs,” vague complaints lacking clear diagnostic roots. These visits accelerated before peaking in the year before diagnosis.
Later, between four and eight years before MS onset, visits related to sensory issues (such as vertigo or a change in vision), musculoskeletal pain, and nervous system complaints appeared to be more common.
For example, visual disturbances appeared much more often around eight years before symptom onset. And rates jumped more than three times over those seen in the control group by the year of diagnosis.
Some of these symptoms – dizziness, fatigue, migraines, and musculoskeletal issues – might not raise red flags for neurologists, especially without context. But, as the authors note, when viewed in aggregate and retrospectively, they form a clear pattern suggesting early MS.
Broader Implications
While earlier studies have hinted at a prodromal phase for MS, they tended to focus on a much smaller window of roughly five years. Most also anchored their analysis to the first demyelinating event, rather than the onset of symptoms.
By extending the observation window to 25 years and anchoring it to clinician-confirmed symptom onset, this study offers a more granular look at how MS might unfold long before traditional markers show up on a scan.
These findings could transform how clinicians consider diagnosis, risks, and even early intervention. It also reinforces the complexity of MS as well as the importance of pattern recognition in its early stages. It also signals a broader shift in how neurologists and researchers might approach not just MS, but other chronic neurological conditions with long, quiet onramps.
Further Reading
Comorbidity Compounds Disease Activity in MS Patients
