EAN 2026 | A debate at EAN 2026: does prodromal MS exist?

So prodromal MS is a topic that we have been interested in for a while now, research-wise. And I think it’s no question that signs that precede multiple sclerosis, clinically overt multiple sclerosis, occur early on. It’s five to ten years before the classic MS onset. The question is about the nomenclature, the terminology, whether we should call it prodromal MS. So I’m not really going to argue that there’s nothing like prodromes in MS. I’m just going to say that we should actually name it that it’s early MS, that it’s biological MS already that gives you prodromal symptoms or signs. And these symptoms and signs that occur early, before classic MS relapses, are very nonspecific. However, if you look closer, most of them could be related to MS pathology, only that not easily detectable on standard methodology. So, prodromes include anxiety, for instance, non-specified vertigo that will not take a form of relapse. It could be depression, it could be insomnia, but it could be also some urinary urgency or sphincter problems, constipations, gastrointestinal symptoms. And when we look at a patient’s history, after they have already been diagnosed with MS, so retrospectively, we see that they actually seek help for a while. So their bodies obviously are signaling that there’s something wrong. It’s just that it’s not yet defined as classic MS. So what I’m going to argue is that these could be mapped to MS pathology, and I’m going to share some insights from the work I do with the Mayo Clinic in Rochester, Minnesota, where I also work as a research collaborator, and where we show that in normal-appearing white matter, there is a vast array of pathology that could give unspecific symptoms and signs like in the so-called prodromal MS, which I think technically is biological MS already.

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