Researchers discovered that multiple sclerosis (MS) prodromal symptoms may yield important indications on the course of the disease and the eventual level of disability, and published their findings in Medical Hypotheses.

MS often presents in early childhood. The type and severity of symptoms are thought to be dependent on the site and size of the central nervous system lesion. Before patients receive a diagnosis, they often experience prodromal symptoms.

“Prodromal symptoms and their effects on the course of MS are poorly studied and often underdiagnosed, so it should be taken into consideration to evaluate and establish possible links when predicting the severity of the disease and disability,” the authors of the study wrote.

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They hence hypothesized that MS prodrome symptoms may impact the course and severity of the disease. The research team conducted a study at the Department of Neurology of the Lithuanian University of Health Sciences Hospital Kaunas Clinics. They recruited 166 patients who had a diagnosis of MS according to the 2010/2017 McDonald Diagnostic Criteria.

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Selected participants were sent questionnaires about the demographics and clinical features of their disease. In addition, the research team collected data from medical records to get a fuller picture of the medical history of the participants.

The results demonstrated that nearly half of the participants reported prodromal symptoms prior to the appearance of typical MS symptoms, such as cardiovascular disease (ie, faster or stronger heartbeats, syncope, mucous membranes color change) and mental disorders (ie, depression, anxiety, cognitive and memory impairment). A smaller proportion of patients (36.7%) experienced gastrointestinal disorders as prodrome symptoms.

The authors of the study reported that patients who experienced gastrointestinal prodrome symptoms were more likely to be diagnosed with relapsing-remitting MS compared to other forms of the disease. In addition, the Expanded Disability Status Scale scores during the last visit were poorer among patients who experienced gastrointestinal disorders during the prodromal period. Patients who experienced anxiety and insomnia as prodromal symptoms tended to experience a milder course of the disease.


Vienažindytė I, Cesarskaja J, Vaičiulytė D, Balnytė R, Matijošaitis V. Do prodrome symptoms influence multiple sclerosis disease course and severity? Med Hypotheses. Published online June 6, 2022. doi:10.1016/j.mehy.2022.110888