• Posted September 27, 2023

Emotional Issues Could Be Early Sign of MS

A newer understanding of multiple sclerosis (MS) suggests that psychiatric conditions like anxiety and depression may emerge long before classic MS symptoms.

“For a long time, it was thought that MS only really began clinically when a person experienced their first demyelinating event, such as in the form of vision problems,” said senior author Helen Tremlett. She is a professor of neurology at the University of British Columbia's Djavad Mowafaghian Center for Brain Health, in Vancouver.

“But we've come to understand there is a whole period preceding those events where the disease presents itself in more indirect ways,” Tremlett said in a university news release.

The findings were welcomed by Sharon Roman, an MS patient for 25 years.

“We take many things in life for granted -- walking, balance, vision, speech, even the simple act of swallowing -- until one day it's taken from us by MS,” Roman said in the news release. “The better we can identify the early signs and symptoms of MS, the earlier we can recognize, diagnose and treat it. We can help prevent people from being diagnosed the way I was, with a massive attack and hospitalization, and prevent the losses I've experienced. Earlier treatment may help slow progression.”

MS is an autoimmune disorder with varied symptoms that can make it harder to diagnose and more easily confused with other conditions.

In MS, the immune system attacks the protective sheath called myelin that covers nerve fibers. This disrupts communication to and from the brain.

The early stages of a disease, known as prodromal periods, are well established in other diseases such as Parkinson's, where people experience symptoms such as constipation years before they begin having the better-known motor deficiencies.

“If we can recognize MS earlier, treatment could begin sooner. That has tremendous potential to slow disease progression and improve quality of life for people,” Tremlett said.

The researchers studied this using health records for more than 6,800 MS patients in British Columbia.

They examined how common mental health conditions -- including depression, anxiety, bipolar disorder and schizophrenia -- were in the five years before patients began experiencing the more well-known symptoms of MS.

The researchers also compared these patients to nearly 32,000 people without MS.

The investigators found that MS patients experienced mental illness at nearly twice the rate of the general population, 28% compared to 15%. Physician and psychiatrist visits, prescriptions for these conditions and related hospitalizations were also consistently higher among MS patients.

In each of the five years leading up to the onset of disease, that gap grew.

“We see higher and higher rates of psychiatric conditions that peak in the final year before MS onset,” said first author Dr. Anibal Chertcoff, who conducted the study as a postdoctoral fellow in Tremlett's lab and is now an assistant professor at the University of Manitoba. “While we're not suggesting that these conditions alone can be a predictor of MS, they may be one piece of the MS prodrome puzzle and a potential signal when combined with other factors.”

Tremlett's lab had previously identified fatigue, sleep disorders, irritable bowel syndrome, anemia and pain as potential parts of the MS prodrome.

The study findings were published Sept. 25 in the journal Neurology. The study was supported by the National Multiple Sclerosis Society, MS Society of Canada and Michael Smith Health Research BC.

More information

The National MS Society has more on multiple sclerosis.

SOURCE: University of British Columbia, news release, Sept. 25, 2023