MS Could Begin More Than a Decade Before Symptoms – New Research Rewrites the Timeline

New research suggests that multiple sclerosis may begin influencing patients’ health far earlier than previously recognized.

Multiple sclerosis (MS) is often recognized only after unmistakable neurological problems show up, such as changes in vision, balance, or sensation. But a new study from the University of British Columbia suggests the body may be signaling trouble much earlier, in ways that look ordinary on their own and are easy to chalk up to everyday health issues.

Reporting in JAMA Network Open, the researchers examined provincial health records from more than 12,000 people in British Columbia. Long before anyone could clearly point to MS, the group that eventually developed the disease was already using medical services more frequently. That shift began about 15 years before their first MS symptoms appear.

Instead of focusing on a single dramatic event, the team traced a long arc of care seeking that included family doctors, specialists, emergency departments, and imaging services. The picture that emerges is less like a sudden onset and more like a slow buildup, with patients repeatedly returning for answers to symptoms that can be frustratingly hard to pin down.

Shifting the Timeline of MS Onset

“MS can be difficult to recognize as many of the earliest signs—like fatigue, headache, pain and mental health concerns—can be quite general and easily mistaken for other conditions,” said senior author Dr. Helen Tremlett, professor of neurology at UBC’s faculty of medicine and investigator at the Djavad Mowafaghian Centre for Brain Health. “Our findings dramatically shift the timeline for when these early warning signs are thought to begin, potentially opening the door to opportunities for earlier detection and intervention.”

To investigate this earlier window, researchers linked provincial clinical and administrative health data to examine physician visits during the 25 years before symptom onset. The starting point of symptoms was determined by a neurologist using detailed medical histories and clinical evaluations.

This is the first study to trace healthcare use so far back in patients’ medical histories. Earlier research generally focused only on the five to ten years before a person’s first demyelinating event (such as vision problems), relying mainly on administrative data. That milestone typically occurs later than the neurologist identified onset of initial symptoms used in this study.

A Gradual Increase in Healthcare Use

The findings revealed that, when compared to the general population, people with MS had a steady build-up of healthcare engagement over 15 years with different types of doctor visits increasing at distinct points in time:

• 15 years before symptom onset: Visits to general practice physicians increased, as did visits to any physician for symptoms like fatigue, pain, dizziness, and mental health conditions, including anxiety and depression.
• 12 years before: Visits to a psychiatrist increased.
• Eight to nine years before: Visits to neurologists and ophthalmologists increased, which could relate to issues like blurry vision or eye pain.
• Three to five years before: Emergency medicine and radiology visits increased.
• One year before: Physician visits across multiple specialties peaked, including neurology, emergency medicine, and radiology.

Evidence of a Long Prodromal Phase

“These patterns suggest that MS has a long and complex prodromal phase—where something is happening beneath the surface but hasn’t yet declared itself as MS,” said Dr. Marta Ruiz-Algueró, a postdoctoral fellow at UBC and the study’s first author. “We’re only now starting to understand what these early warning signs are, with mental health-related issues appearing to be among the earliest indicators.”

The study builds on previous work by Dr. Tremlett and her team to characterize the early stages of MS, or prodromal phase, when subtle symptoms appear before the hallmark signs become recognizable. Prodromal periods are well established in other neurological disorders, like Parkinson’s disease, where mood changes, sleep disturbances and constipation often arise years before the more familiar motor symptoms like tremors and stiffness.

While the researchers caution that the vast majority of people who experience general symptoms will not go on to develop MS, they say recognizing and characterizing the MS prodrome could one day help accelerate diagnosis and improve outcomes for patients.

“By identifying these earlier red flags, we may eventually be able to intervene sooner—whether that’s through monitoring, support, or preventive strategies,” said Dr. Tremlett. “It opens new avenues for research into early biomarkers, lifestyle factors, and other potential triggers that may be at play during this previously overlooked phase of the disease.”

Funding: National MS Society, MS Canada

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