Early warning signs of MS appear years before diagnosis and affect all communities in similar ways

A major UK study has revealed that the early warning signs of multiple sclerosis (MS) - including pain, mood changes, and neurological symptoms such as numbness and tingling – may appear years before diagnosis and affect all communities in similar ways.

Researchers at Queen Mary University of London analysed electronic health records of more than 96,000 people, including 15,000 people with MS, making this one of the largest and most diverse investigations into the MS prodrome – the constellation of non-specific symptoms experience by people with MS before a diagnosis– to date. While the MS prodrome is a well-documented phenomenon, little is known about whether or how symptoms during this period vary depending on ethnicity or socio-economic status. A better understanding of this phase across the entire population could help our understanding of the onset of the disease and could aid in early diagnosis. 

The study, published in Annals of Clinical and Translational Neurology, confirms that these early symptoms are consistent across gender, ethnicity and socio-economic backgrounds, strengthening the case for these symptoms being used to help detect MS earlier. 

The researchers found that, in the five years before diagnosis, people with MS were: 

• 8 times more likely to report neurological symptoms such as vision changes or numbness 
• 2.5 times more likely to have memory or concentration problems 
• Twice more likely to report chronic pain or bladder/bowel issues 
• 1.7 times more likely to experience depression or anxiety 

These patterns hold true for people of White, Black, South Asian and mixed/other ethnicities, as well as those living in both rural and urban areas. 

This is the strongest evidence yet that MS gives us clues years before diagnosis. If doctors know what to look for, they can potentially spot the disease earlier and act to start treatment before significant damage is done."

Ruth Dobson, Professor of Clinical Neurology at Queen Mary and lead author of the study

Interestingly, the link between neurological symptoms and later MS diagnosis was even stronger for men and people from Black and Asian backgrounds. These are groups that are often typically less likely to be diagnosed with MS overall. 

Ben Jacobs, Clinical Lecturer in Neurology at Queen Mary and co-author on the study said: "Our study shows that the very earliest features of MS are similar regardless of someone's ethnic or socio-economic background. Efforts to detect MS earlier or identify people at high risk should therefore be inclusive and representative of the whole population." 

Why it matters 

MS is a chronic neurological condition affecting 150,000 people in the UK and more than two million people worldwide. Early diagnosis and treatment can slow progression, reduce disability and improve quality of life. 

However, diagnosis is often delayed until a major neurological episode occurs, sometimes after years of unexplained symptoms. These new findings could help doctors identify people at high risk much sooner. 

Dr Catherine Godbold, Senior Research Communications Manager at the MS Society, says: "Understanding more about the early signs of MS could help speed up MS diagnosis and get people onto treatments sooner. This can help to slow down disease progression and prevent disability. So, we're really pleased to see these early symptoms being studied in a large, diverse group. 

"Over 150,000 people live with MS in the UK, and the condition can affect all communities, ages, ethnic backgrounds and genders. But almost everything we know about how MS develops is based on people of White ethnicity. Research like this is crucial in helping us ensure healthcare services can benefit everyone living with MS and those at an increased risk of developing the condition, regardless of their background." 

The research team is now working on risk prediction tools that could flag high-risk individuals for closer monitoring or referral. This could pave the way for trials of preventive treatments, shifting MS care from reactive to proactive. 

The study used anonymized data from the Clinical Practice Research Datalink (CPRD) Aurum, which covers around 20 per cent of the UK population. It was funded by the National Multiple Sclerosis Society (NMSS).