However, epidemiology studies suggest that you develop the risk for MS in your mid teens.
So can MS be picked up before diagnosis is there a Prodrome, which is an early symptom indicating the onset of the condition?
We know from exam results done in Argentina, that people destined to develop MS, can do a bit worse in their exams. This suggests that MS is present before it rears its head. We know there is diasease activity before MS as this is occasionally caught by people who have an MRI and show a radiologically isolated syndrome.
In this study they look to see if there are symptoms that suggest that MS is coming.
Here they search through health records 5 years before the first noticed clinical event, leading to the diagnosis of MS.
Paper
Wijnands JM, Zhu F, Kingwell E, Zhao Y, Ekuma O, Lu X, Evans C, Fisk JD, Marrie RA, Tremlett H. Mult Scler. Five years before multiple sclerosis onset: Phenotyping the prodrome. 2018:1352458518783662.
BACKGROUND:The multiple sclerosis (MS) prodrome is poorly characterized.
OBJECTIVE:To phenotype the MS prodrome via health care encounters.
METHODS:Using data from a population-based cohort study linking administrative and clinical data in four Canadian provinces, we compared physician and hospital encounters and prescriptions filled (via International Classification of Diseases chapters, physician specialty or drug classes) for MS subjects in the 5 years before the first demyelinating claim in an administrative cohort or the clinical symptom onset in an MS clinic-derived cohort, to age-, sex- and geographically matched controls. Rate ratios (RRs), 95% confidence intervals (95% CIs) and proportions were estimated.
RESULTS:The administrative and clinical cohorts included 13,951/66,940 and 3202/16,006 people with and without MS (cases/controls). Compared to controls, in the 5 years before the first demyelinating claim or symptom onset, cases had more physician and hospital encounters for the nervous (RR (range) = 2.31; 95% CI: 1.05-5.10 to 4.75; 95% CI: 3.11-7.25), sensory (RR (range) = 1.40; 95% CI: 1.34-1.46 to 2.28; 95% CI: 1.72-3.02), musculoskeletal (RR (range) = 1.19; 95% CI: 1.07-1.33 to 1.70; 95% CI: 1.57-1.85) and genito-urinary systems (RR (range) = 1.17; 95% CI: 1.05-1.30 to 1.59; 95% CI: 1.48-1.70). Cases had more psychiatrist and urologist encounters (RR (range) = 1.48; 95% CI: 1.36-1.62 to 1.80; 95% CI: 1.61-2.01), and higher proportions of musculoskeletal, genito-urinary or hormonal-related prescriptions (1.1-1.5 times higher, all p < 0.02). However, cases had fewer pregnancy-related encounters than controls (RR = 0.78; 95% CI: 0.71-0.86 to 0.88; 95% CI: 0.84-0.92).
CONCLUSION: Phenotyping the prodrome 5 years before clinical recognition of MS is feasible
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My comments
People with MS had twice the number of nervous system related events but the others were marginally above the norm. The conclusion is that the prodrome is feasible, but one would need to see if there is any specificity for MS here. I doubt it. Would there be any real predictive value probably not.The next question we have to think about is, if there was an MS prodrome what would you do about it?
To date efforts to prevent MS are thin on the ground. Maybe stopping people getting glandular fever would be a start.