Early signs of MS may include symptoms of depression and anxiety.

New research from the University of British Columbia has provided a clearer understanding of the early indicators of multiple sclerosis (MS). The study, published in the medical journal Neurology, affiliated with the American Academy of Neurology, reveals that individuals are nearly twice as likely to undergo mental health challenges in the years preceding the onset of the disease.

Dr. Helen Tremlett, a senior author and a professor of neurology at UBC, explained, “For a long time, it was thought that MS only really began clinically when a person experienced their first demyelinating event, such as in the form of vision problems. But we’ve come to understand there is a whole period preceding those events where the disease presents itself in more indirect ways.”

Multiple sclerosis is an autoimmune condition that involves the immune system attacking the protective sheath (myelin) surrounding nerve fibers, disrupting communication to and from the brain. Recognizing MS can be complex for medical professionals as its symptoms can mimic those of other conditions, leading to a prolonged and uncertain path to diagnosis.

Dr. Tremlett and her team have been striving to better define the early stages of MS with the aim of enabling earlier detection and potential intervention. Similar preliminary phases are well-documented in other diseases like Parkinson’s, where symptoms such as constipation manifest years before typical motor deficiencies emerge.

“If we can identify MS earlier, treatment could commence sooner. That holds tremendous potential to slow disease progression and enhance the quality of life for individuals,” emphasized Dr. Tremlett.

In this study, researchers examined the health records of 6,863 MS patients in B.C. They assessed the prevalence of mental health conditions, including depression, anxiety, bipolar disorder, and schizophrenia, in the five years leading up to when patients exhibited medically recognized signs of MS. These MS patients were compared to 31,865 patients without MS.

The findings unveiled that MS patients experienced mental health conditions at nearly double the rate of the general population, with rates of 28.0% and 14.9% respectively. Healthcare utilization for psychiatric symptoms, such as visits to physicians and psychiatrists, prescriptions, and hospitalizations, was consistently higher among MS patients. Importantly, this discrepancy widened in each of the five years preceding the onset of the disease.

“We see higher and higher rates of psychiatric conditions that peak in the final year before MS onset,” noted Dr. Anibal Chertcoff, the first author of the study. “While we’re not suggesting that these conditions alone can be a predictor of MS, they may be one piece of the MS prodrome puzzle and a potential signal when combined with other factors.”

This study builds on earlier work from Dr. Tremlett’s lab, indicating that additional symptoms such as fatigue, sleep disorders, irritable bowel syndrome, anemia, and pain may also be part of the MS prodrome.

For Sharon Roman, who has lived with MS for 25 years, a more precise characterization of this prodromal period could bring substantial benefits for patients. Roman stated, “We take many things in life for granted — walking, balance, vision, speech, even the simple act of swallowing — until one day it’s taken from us by MS…Earlier treatment may help slow progression.” This study received support from the National Multiple Sclerosis Society, MS Society of Canada, and Michael Smith Health Research BC.

Remember, if you need further guidance or support, don’t hesitate to reach out to your mental health professional or contact us for assistance.