Multiple Sclerosis: 5 Critical Warning Signs Revealed

What if the molecular pathways that produce MS were activated years before clinical diagnosis? This is the conclusion of a new study published in Neurology by a team from the Paris Brain Institute. On a broad scale, the incidence of illnesses such as depression, constipation, and urinary tract infections is connected with a diagnosis of multiple sclerosis five years later, according to the study. These findings highlight a prodromal phase of the disease, but they do not allow for the development of an early detection approach at this time.

Multiple sclerosis (MS) is a neurological illness in which the immune system assaults myelin, the protective wrapping of nerve fibers that plays an important role in nerve impulse transmission between the brain and peripheral organs. MS affects 120,000 people in France, and management has improved significantly over the previous ten years. Unfortunately, there is still no cure—and no therapeutic option for the 15% of individuals who have a progressive type.

“One of the major difficulties with multiple sclerosis is that we do not observe a strict correspondence between the severity of lesions on nerve fibers and patients’ symptoms. This considerably limits our ability to predict the course of the disease,” Prof. Céline Louapre, a neurologist at Pitié-Salpêtrière Hospital and head of Paris Brain Institute’s clinical investigation center, explains.

“The challenge today is to detect the disease as early as possible, well before the lesions are visible on MRI, in the hope of delaying the onset of disability.”

Several investigations have already revealed that modest symptoms were present in some patients up to ten years before diagnosis. What remained was to carefully define a “prodromal phase” of multiple sclerosis, i.e., a period during which the disease takes hold discretely, at the population size. Furthermore, a greater understanding of the early signs of MS may aid researchers in pinpointing the precise moment when the inflammatory process that generates lesions in the central nervous system begins.

Leveraging massive epidemiological data

Pr. Céline Louapre, along with Octave Guinebretière and Thomas Nedelac, compared the health data of 20,174 patients with multiple sclerosis, 54,790 patients without MS, and 37,814 patients affected by two autoimmune diseases that, like MS, primarily affect women and young adults—30,477 patients with Crohn’s disease and 7,337 patients with lupus.

The team examined the health trajectory of these patients using anonymized medical information from the UK’s Health Improvement Network (THIN), concentrating on the incidence of 113 common symptoms and illnesses five years before and five years after diagnosis. A comparable time frame was employed for control patients who did not have an autoimmune illness.

Depression, sexual difficulties, constipation, cystitis, and other urinary tract infections were found to be significantly related with a later diagnosis of multiple sclerosis by the researchers.

“This association was sufficiently robust at the statistical level for us to state that these are early clinical warning signs, probably related to damage to the nervous system, in patients who will later be diagnosed with multiple sclerosis,” Prof. Céline Louapre explains. “The overrepresentation of these symptoms persisted and even increased over the five years after diagnosis.”