Silent and early autoimmune disease
Sclerosis in plates (MS) is a chronic autoimmune disease that affects the central nervous system, disturbing communication between the brain and the rest of the body. At the origin of this disorder, there is an involvement of the myelin sheath, which surrounds the nerve fibers and plays an essential role in the electrical conduction of the nervous influx.
This disease mainly affects young adults, with a majority of women among patients. The first neurological symptoms such as visual or motor disorders often appear around 30 years old. But before that, many signals can be present … without being linked to the disease.
Dr. Helen Tremlett, neurologist and main author of the study, recalls that “Multiple sclerosis can be difficult to recognize because many of the first signs – such as fatigue, headache, pain and mental health problems – are quite general and easily confused with other pathologies“.
Fatigue, pain, anxiety: 15 years of silent alert
Published in Jama Network Openthis research from the University of British Columbia is the first to have analyzed the medical history of patients up to 25 years before the appearance of the disease. Researchers have crossed health administrative data with clinical neurologists to precisely date the first symptoms.
So far, the majority of studies only went up to 5 or 10 years before the first demyelinating episode. This new approach made it possible to identify a much longer prodromic phase, marked by increased consumption of care. The “prodromic phase” designates the period during which various signs and precursor symptoms appear, often light, which precede the appearance of the main phase of the disease. As Dr. Marta Ruiz – Algueró describes: “These patterns suggest that multiple sclerosis has a long and complex prodromal phase, during which changes occur below the surface, without clearly manifesting as a MS (…) The problems related to mental health seem to be among the first indicators“.
The results show a gradual increase in different types of medical consultations in the years preceding the diagnosis:
- 15 years before the symptoms : increase in visits to generalists, for complaints such as fatigue, pain, dizziness or anxiety and depression;
- 12 years before : increase in psychiatric consultations;
- 8 to 9 years old before : increase in meetings with neurologists and ophthalmologists, especially in connection with visual disturbances;
- 3 to 5 years before : increased frequentation of emergency and radiology services;
- 1 year before : peak of consultations in several specialties, notably in neurology, emergency medicine and radiology.
Towards a turning point for early diagnosis
These discreet signals, often ignored, could serve as precious alerts to intervene much earlier in the care path. Dre Helen Tremlett insists: “By identifying these early alert signals, we could ultimately intervene more quickly – whether by reinforced monitoring, support or preventive strategies“.
Behind this study, a promise is emerging: refining the identification of patients at risk to slow the progression of the disease, or even act before the appearance of neurological symptoms.
Open new research avenues
The SEP prodromal period has so far been neglected, due to the lack of reliable data. Now it becomes a new field of exploration for researchers. As Dre Tremlett sums it up: “This opens up new research perspectives on early biomarkers, factors related to lifestyle and other potential triggers that can intervene during this phase of the disease, until then neglected“.
By better understanding this silent phase, medicine could one day not only anticipate the MS, but also prevent it from settled.