EAN 2026 | Distinguishing true early MS pathology from coincidental or non-specific pre-diagnostic features
Alicja Kalinowska, MD, PhD, Poznań University of Medical Sciences, Poznań, Poland, shares insights into diagnosing multiple sclerosis (MS) in patients with prodromal signs, highlighting the importance of objectifying patient complaints and using MRI biomarkers to distinguish MS on biological grounds. Prof. Kalinowska notes that early signs of MS can be detected through measures such as the modified fatigue impact scale, urinary bladder diary, and cognitive tests, allowing for earlier diagnosis and attribution of symptoms to MS. This interview took place at the 12th Congress of the European Academy of Neurology (EAN) in Geneva, Switzerland.
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Transcript
So there’s several aspects to that. If we have a patient who has prodromal signs, so early signs, without classic relapses or progression, and this patient already has lesions on MRI, so they have radiologically isolated syndrome, in most cases we will actually be able to diagnose them with MS already, even if they have no specific symptoms. So this has changed dramatically since the last update of the McDonald criteria, where we can distinguish MS based on biology, based on MRI, especially with new biomarkers such as central vein sign or paramagnetic rim lesion signs...
So there’s several aspects to that. If we have a patient who has prodromal signs, so early signs, without classic relapses or progression, and this patient already has lesions on MRI, so they have radiologically isolated syndrome, in most cases we will actually be able to diagnose them with MS already, even if they have no specific symptoms. So this has changed dramatically since the last update of the McDonald criteria, where we can distinguish MS based on biology, based on MRI, especially with new biomarkers such as central vein sign or paramagnetic rim lesion signs. But the other aspect is to actually verify whether the patient’s complaints are actually grounded in biology. And this we can do by objectifying the patient’s complaints. So, for instance, if the patient’s main complaint is fatigue, then we can measure it with, for instance, modified fatigue impact scale that we use for MS. If they say that they have some urinary problems, we can ask them to do a diary, urinary bladder diary, and we can also measure if there’s some post-void residual volume of the urine. And these are actually early signs of MS. Same goes for cognitive fatigue, for cognitive complaints. A lot of patients that were previously diagnosed with RIS, for instance, they actually did complain of symptoms and signs that were neglected by doctors because they were not objectified. So if you do BICAMS or other neuropsychological psychometric testing in those patients, you will see that they actually have deficits. And then it’s no question, especially if they have lesions on MRI, whether it’s MS-related or not. You, of course, attribute it to MS. The problem is with those patients who do not yet have lesions on MRI. But for now, since the prodromal phase has been discussed in MS for the last 10 years or so, we have no data on those patients who have prodromes but no lesions on MRI. However, I have to stress that the majority of patients who have prodromes actually will see a doctor for their complaints and they will have MRI for those unspecific symptoms and signs and then RIS will be detected that usually will fulfill MS criteria.
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