EAN 2026 | Clinical implications of rejecting the prodromal MS framework

Well, it’s the matter of, I would say, nomenclature, as I stated before. So it’s not whether it’s present or not. It’s just a matter how we define it, and that has impact on how we handle patients with unspecific complaints. There have even been proposed some algorithms where if you have a patient who presents with fatigue, urinary complaints, or cognitive complaints, these patients should be assessed for autoimmunity in the family, maybe EBV infection status, vitamin D supplementation status, whether they are in deficit or not, and then they should actually be directed to have neuroimaging done. So we should not take the prodromal complaints so lightly and actually dig deeper into these. And what we have found in our research, which I think is very clinically meaningful, is that patients who have complaint of urinary symptoms, they do worse in the long term. And part of this, they usually have higher EDSS and so on compared to other individuals. So if this was their first complaint and if this was diagnosed early on, their diagnosis of MS would be earlier, the treatment would be earlier. And that’s the key message here, that if you diagnose MS at this preclinical phase, even without obvious MS clinical outlook, then you might actually prevent, like with RIS, future progression. And we have seen this shift for RIS, and I’m quite sure that we’re going to see it soon for the so-called prodromal phase. The one thing that we need to work on is actually to find a biological marker that, other than objectifying the complaints, will be able to confirm, like oligoclonal bands for instance, which is obviously an invasive procedure, you have to do a spinal tap, but maybe look for more immunological signatures, for instance, that will tell us the patient is rather of an MS pathology than non-specific prodromes.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.