Key Questions Answered
Q: How early can signs of multiple sclerosis appear?
A: This large study detected increased healthcare use linked to MS-related complaints as far back as 15 years before an official diagnosis.
Q: What early symptoms did people with MS report?
A: People later diagnosed with MS commonly sought care for non‑specific problems such as persistent fatigue, pain, dizziness, anxiety and depression years before clear neurological signs.
Q: Why does this matter?
A: The results expand our understanding of the MS prodrome and suggest opportunities for earlier recognition, monitoring and research into prevention or timely intervention.
Summary: A comprehensive analysis of clinical and administrative records in British Columbia finds that subtle, non-specific symptoms and increased healthcare engagement often begin more than a decade before neurologists record the first demyelinating event associated with multiple sclerosis (MS). The study shows a gradual, measurable rise in visits to physicians for general complaints—especially primary care and mental health concerns—up to 15 years prior to symptom onset as determined by clinical assessment.
These findings point to a prolonged prodromal phase in MS—an interval when vague symptoms precede the better-known neurological manifestations. Recognizing this extended timeline can help clinicians and researchers spot early warning signs, refine diagnostic pathways, and prioritize studies of early biomarkers, lifestyle factors and preventive strategies.
Key Facts
- Long prodrome: Healthcare use rises steadily over roughly 15 years before MS symptom onset.
- Early indicators: Fatigue, dizziness, pain, mood and anxiety problems, and ill‑defined complaints often appear first.
- Shift in clinical view: The data challenge the idea that MS only begins with clear neurological signs like vision loss or focal deficits.
Source: University of British Columbia
Researchers at the University of British Columbia analyzed linked provincial health records and MS clinic data for more than 12,000 people to map patterns of physician visits in the 25 years before a neurologist‑determined MS symptom onset. Published in JAMA Network Open, the study represents one of the most detailed explorations of healthcare engagement in the years leading up to MS diagnosis and highlights how patients often seek help repeatedly for diffuse complaints before receiving a neurological diagnosis.
Dr. Helen Tremlett, senior author and professor of neurology at UBC, notes that early MS signs—such as persistent fatigue, headaches, pain and mental health disturbances—are often non‑specific and easily attributed to other causes, which can delay recognition. The study’s detailed timeline shows when different types of physician visits start to rise relative to the later clinician‑documented symptom onset:
• Around 15 years before symptom onset: Primary care and general physician visits increase, driven by complaints like fatigue, pain, dizziness and mood symptoms.
• About 12 years before: Psychiatric visits begin to rise, suggesting early mental health impacts.
• Eight to nine years before: Visits to neurologists and ophthalmologists increase, consistent with early visual or neurological concerns.
• Three to five years before: Emergency department and radiology use goes up.
• The year before onset: Physician visits across multiple specialties peak, including neurology, emergency care and diagnostic imaging.
First author Dr. Marta Ruiz‑Algueró, a postdoctoral fellow at UBC, emphasizes that these patterns reflect a gradual, multi‑stage prodromal phase. Mental health and ill‑defined symptom codes were among the earliest measurable signals, appearing well in advance of nervous system complaints that later prompted specialist referrals.
The study compared 2,038 patients with MS (mean age at symptom onset 37.9 years; 74% female) to 10,182 matched individuals from the general population. All‑cause physician visit rates were consistently higher in the MS group from about 14 years before symptom onset and rose further in the year leading up to onset. Visit rate ratios for ill‑defined symptoms were elevated from 15 years before onset and peaked the year before, while mental health–related visit ratios were significant from roughly 14 years before onset.
Specialty‑level findings showed general practice visits were elevated across the 15 years prior to symptom onset, psychiatry visits rose about 12 years before onset, and neurology and ophthalmology visits were higher up to 8–9 years out, with sharp increases close to symptom onset.
Although the authors caution that most people who experience fatigue, pain or mood symptoms will not develop MS, mapping this long prodromal phase could change clinical thinking and fuel research into early detection. Identifying earlier red flags may enable closer monitoring, supportive care and investigation of preventive measures that could improve long‑term outcomes.
About this multiple sclerosis research news
Author: Reyhana Heatherington
Source: University of British Columbia
Contact: Reyhana Heatherington – University of British Columbia
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Healthcare use before multiple sclerosis symptom onset” by Helen Tremlett et al. JAMA Network Open
Abstract
Healthcare use before multiple sclerosis symptom onset
Importance
Health care use increases before multiple sclerosis onset. Previous work often focused on the 5–10 years prior to a first administrative demyelinating code; few studies examined patterns before clinician‑determined symptom onset.
Objective
To investigate health care use up to 25 years before clinically determined MS symptom onset in a British Columbia cohort.
Design, Setting, and Participants
This matched cohort study used prospectively collected data from January 1991 to September 2018, released mid‑2024 for analysis. Patients with MS were identified from clinic records and matched with up to five people from the general population by sex, birth year, socioeconomic status and postal code. Data came from British Columbia’s publicly funded health system.
Main Outcomes and Measures
Linked clinical and administrative records were used to compare physician visit rates up to 25 years before MS onset, applying adjusted negative binomial models and examining visits by ICD‑9 category and physician specialty in the 15 years before onset.
Results
The study included 2,038 patients with MS (mean age at symptom onset 37.9 years; 74.0% female) and 10,182 matched individuals. All‑cause physician visit rate ratios were elevated from about 14 years before onset and peaked in the year before onset. Ill‑defined symptom visit ratios were increased from 15 years before onset, and mental health visit ratios were significant from 14 years before onset. Sensory, musculoskeletal and nervous system visit ratios rose 8, 5 and 4 years before onset respectively. General practice visits were elevated across the 15 years before onset, psychiatry visits rose about 12 years prior, and neurology and ophthalmology visits were higher up to 8–9 years before onset.
Conclusions and Relevance
In this matched cohort study, people who later developed MS showed higher health care use 14–15 years before clinically determined symptom onset. Early features of this prodromal period included mental health and ill‑defined symptoms, which preceded nervous system and neurological visits by several years. Recognizing this extended prodrome may reshape approaches to early detection and research into mechanisms and prevention.