It suggests that psychiatric conditions like anxiety and depression may be part of a
“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,” said senior author Dr. Helen Tremlett, professor of neurology at UBC and member of the Djavad Mowafaghian Centre for Brain Health. “But we’ve come to understand there is a whole period preceding those events where the disease presents itself in more indirect ways.”
MS is an autoimmune disorder in which the immune system attacks the protective sheath (myelin) that covers nerve fibers, disrupting communications to and from the brain. Recognizing MS is often challenging for medical professionals because its symptoms are varied and easily mistaken for other conditions. For many patients, this means the journey toward a diagnosis can be long and filled with uncertainty.
Prodromal periods are well established in other diseases such as Parkinson’s, where people experience symptoms such as constipation years before classical motor deficiencies begin.
“If we can recognize MS earlier, treatment could begin sooner. That has tremendous potential to slow disease progression and improve quality of life for people,” said Dr. Tremlett.
Antecedents to Multiple Sclerosis Influence Early Diagnosis & Treatment
For the study, the researchers examined health records for 6,863 MS patients in B.C. They looked at the prevalence of mental health conditions, including depression, anxiety, bipolar disorder, and schizophrenia, in the five years before patients developed classical, medically recognized signs of MS. These MS patients were compared to 31,865 patients without MS.
The findings revealed that MS patients were experiencing mental illness at nearly twice the rate of the general population, at 28.0 percent and 14.9 percent respectively. Healthcare usage for psychiatric symptoms including physician and psychiatrist visits, prescriptions, and hospitalizations was also consistently higher among MS patients. Notably, the gap widened in each of the five years leading up to disease onset.
“We see higher and higher rates of psychiatric conditions that peak in the final year before MS onset,” said first author Dr. Anibal Chertcoff, who conducted the study as a postdoctoral fellow in Dr. Tremlett’s lab and is now an assistant professor at the University of Manitoba.
The study builds on previous work from Dr. Tremlett’s lab showing that other 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, better defining this prodromal period could have huge benefits for patients.
“The better we can identify the early signs and symptoms of MS, the earlier we can recognize, diagnose, and treat it. We can help prevent people from being diagnosed the way I was, with a massive attack and hospitalization, and prevent the losses I’ve experienced. Earlier treatment may help slow progression.”
- Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis – (https://n.neurology.org/content/early/2023/09/25/WNL.0000000000207843)