Multiple sclerosis (MS) is a partially heritable immune-mediated inflammatory demyelinating, and neurodegenerative disease affecting the CNS, with genetic and environmental factors contributing to disease development.
A prodrome is an early set of signs and symptoms, often non-specific, that indicates the onset of a disease before more classic symptoms occur. Prodromal stages are well recognized in some neurological and immune-mediated diseases such as Parkinson disease, Alzheimer, Schizophrenia, type 1 diabetes mellitus and rheumatoid arthritis.
During the past decade, studies have been published that indicate the existence of a prodrome in multiple sclerosis. Emerging evidence suggests that there is a prodromal period in MS that is measurable as an increase in healthcare use in the years preceding MS onset or diagnosis. Also, it evidenced by increased physician encounters for a diverse range of diagnoses and increased prescription medication use. The symptoms shown to occur 5–10 years before MS symptom onset in people who are subsequently diagnosed with MS. Many of the MS prodromal features characterized thus far are non-specific and are common in the general population (e.g. fatigue, anxiety, depression, migraine and lower cognitive performance ,…); no single feature alone is sufficient to identify an individual with prodromal MS. Biomarkers may increase specificity and accuracy for detecting individuals in the MS prodromal phase, but are yet to be discovered or formally validated.
Identification of individuals in the MS prodromal phase should be based on a combination of clinical features, genetic and environmental factors and magnetic resonance imaging (MRI) and/or laboratory biomarkers. Brain MRI abnormalities are sometimes detected by chance in the white matter in people with no typical symptoms of MS, and these findings are referred to as RIS. RIS may be a prodromal neuroimaging correlate. The next steps would be to combine prodromal symptoms, individual characteristics (Age, sex, comorbidities, …) and biomarkers to develop diagnostic criteria for the MS prodrome, which would allow for early identification and provides opportunity for early management and possibly even prevention of MS in the future.