A recent study published in Neurology suggests that individuals later diagnosed with multiple sclerosis (MS) are more likely to experience various conditions, including depression, constipation, sexual issues, and urinary tract infections (UTIs), up to five years before receiving their MS diagnosis.
The research also highlights a higher occurrence of these conditions in individuals with lupus and Crohn’s disease, both autoimmune conditions.
Study coauthor Celine Louapre, MD, PhD, from Sorbonne University in Paris, suggest that these findings imply that the biological mechanisms triggering multiple sclerosis may be active many years before the manifestation of neurological symptoms and the subsequent diagnosis.
However, since, depression, constipation, and other conditions mentioned here were also found in those with other autoimmune diseases – and happen to be quite common in the general public – Dr. Louapre says that it’s still unlikely that they can be used to diagnose multiple sclerosis at an earlier stage.
“The exception is perhaps for people who are particularly at risk of developing MS, because of a family risk or because patients would already be followed for incidental discovery of CNS [central nervous system] inflammatory lesions on an MRI [magnetic resonance imaging scan],” she adds.
Early Signs of MS May Be Identifiable Long Before Onset of Neurological Symptoms of Diagnosis
Increasing acknowledgement exists regarding the presence of a prodrome in multiple sclerosis (MS) – an early phase marked by various symptoms indicating a heightened risk for the eventual onset and diagnosis of MS, as highlighted in a January 2022 review published in Frontiers in Neurology.
Experts believe that this MS prodromal phase may be detectable at least five years prior to the emergence of MS symptoms or even a decade before an official MS diagnosis.
Numerous signs and symptoms have been identified as more prevalent in the years leading up to the onset of MS. These include cognitive deficits, depression, fatigue, sleep disorders, pain, fibromyalgia, bowel and bladder issues, and various skin conditions.
This growing understanding of the prodromal phase provides valuable insights into the early indicators that may precede the manifestation of clinically apparent MS symptoms, offering opportunities for proactive intervention and management.
Five Symptoms Strongly Linked to Subsequent MS Diagnosis
Examining electronic health records from databases in France and the United Kingdom, investigators identified approximately 20,000 individuals recently diagnosed with MS.
These individuals were carefully compared with a cohort of around 55,000 matched by gender and age with individuals without MS. Additionally, the group of people with MS was juxtaposed with approximately 30,000 individuals diagnosed with Crohn’s disease and 7,000 individuals with lupus.
The research team subsequently conducted a thorough examination of the database, scrutinizing whether participants exhibited one or more of 133 diseases and symptoms in the five years leading up to and following their MS diagnosis. For those without an autoimmune disease, the assessment was performed relative to a matching date.
The findings revealed that, when compared to individuals without MS, those with MS exhibited distinctive patterns in the five years preceding their diagnosis in the following:
- 22 percent more likely to have depression
- 50 percent more likely to have constipation
- 38 percent more likely to have UTIs
- 47 percent more likely to have sexual issues
- 21 percent more likely to have cystitis (bladder infections)
Higher Likelihood of Depression Prior To and Following MS Diagnosis
Digging deeper into the aspect of depression, the study found that 14 percent of individuals with MS had prescriptions for antidepressants five years before their diagnosis, compared to 10 percent of those without MS. Additionally, five years after diagnosis, 37 percent of people with MS had antidepressant prescriptions, contrasting with 19 percent of individuals without MS.
However, Dr. Louapre shares that it’s crucial to note that experiencing these symptoms doesn’t mean it will lead to an MS diagnosis.
The authors also note that one limitation of the study was due to the absence of data on additional factors that might impact individuals’ risk of developing MS, such as educational level, income, and ethnicity.
Could UTIs, Sexual Dysfunction, and Constipation Originate from a Common Underlying Disease Process Shared with MS?
Despite this, the study provides valuable insights into potential early signs of MS and highlights the importance of understanding the biological mechanisms preceding the onset of disease symptoms.
According to Dr. Louapre, the identified symptoms and conditions might be linked to an underlying disease process shared with MS, suggesting early damage to the central nervous system.
“These symptoms may reflect early damage to the central nervous system. For example, urinary disorders, constipation, and sexual disorders could be due to the presence of spinal cord lesions, which would not have resulted in classic motor or sensory neurological symptoms at the time of their appearance,” she says, as spinal cord lesions (abnormal change or damage) are quite common in MS.
“These lesions, even if they are initially non-symptomatic, can disrupt certain circuits, including the neurological circuits which control sphincter functions,” says Dr. Louapre.
Sphincters happen to be the ring-like muscles that allow the constriction of specific body passages, including the ones that control the release of urine, feces, and semen.
“Similarly, MS brain damage can disrupt certain neurological circuits involved in depression, even though classic neurological symptoms are not yet present,” she adds.
What this research hopes to accomplish is that by identifying these early signs, it will help them better understand the biological mechanisms that happen in the body before the actual symptoms of MS develop.
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