The Multiple Sclerosis Prodrome: Evidence to Action

Area of Science:

• Neurology
• Immunology
• Disease Progression

Background:

• A clinically symptomatic prodromal phase preceding multiple sclerosis (MS) diagnosis is increasingly recognized, potentially spanning 5-10 years.
• This early phase, characterized by non-specific symptoms, precedes classical disease onset and diagnosis.
• Understanding the MS prodrome has significant implications for disease prevention, early detection, and prognosis.

Purpose of the Study:

• To provide an overview of recent advances in understanding the multiple sclerosis (MS) prodrome.
• To discuss current challenges in identifying and validating prodromal MS features.
• To highlight the implications of recognizing an MS prodromal phase for future research and clinical practice.

Main Methods:

• This perspective synthesizes current research on the multiple sclerosis (MS) prodrome.
• It reviews characterized prodromal features and discusses diagnostic challenges.
• It considers progress in related neurological and immune-mediated diseases.

Main Results:

• Many identified MS prodromal features are non-specific and common in the general population.
• No single symptom is currently sufficient for identifying prodromal MS.
• Biomarkers are needed to improve the accuracy of detecting individuals in the MS prodromal phase.

Conclusions:

• While knowledge of the MS prodrome is developing, research action is critical.
• Incorporating a prodromal phase into the MS continuum concept is an immediate implication.
• Long-term implications include earlier MS recognition, improved prognosis, and potential disease prevention.