How Early Is Early Multiple Sclerosis?

Abstract

The development and further optimization of the diagnostic criteria for multiple sclerosis (MS) emphasize the establishment of an early and accurate diagnosis. So far, numerous studies have revealed the significance of early treatment administration for MS and its association with slower disease progression and better late outcomes of the disease with regards to disability accumulation. However, according to current research results, both neuroinflammatory and neurodegenerative processes may exist prior to symptom initiation. Despite the fact that a significant proportion of individuals with radiologically isolated syndrome (RIS) progress to MS, currently, there is no available treatment approved for RIS. Therefore, our idea of “early treatment administration” might be already late in some cases. In order to detect the individuals who will progress to MS, we need accurate biomarkers. In this review, we present notable research results regarding the underlying pathology of MS, as well as several potentially useful laboratory and neuroimaging biomarkers for the identification of high-risk individuals with RIS for developing MS. This review aims to raise clinicians’ awareness regarding “subclinical” MS, enrich their understanding of MS pathology, and familiarize them with several potential biomarkers that are currently under investigation and might be used in clinical practice in the future for the identification of individuals with RIS at high risk for conversion to definite MS.

The Time Trajectory of Choroid Plexus Enlargement in Multiple Sclerosis

“…It is important to note that plexus alterations do not seem to be specific to MS. CP enlargement has also been reported in disease states linked with inflammation such as meningitis, depression, psychosis, schizophrenia, complex regional pain syndrome, epilepsy, ischemic stroke, hypoxia, obesity, as well as in primary neurodegenerative disorders, such as Alzheimer's, frontotemporal dementia, Huntington's disease, and Parkinson disease, as well as normal aging [7,[46][47][48]51,56,[62][63][64][65][66][67][68][69][70][71][72][73][74]. As such, CPV increase does not fulfill the established criteria of either a diagnostic or prognostic marker in MS [75], and up to now, there is no indication that it could replace the current clinical and radiological assessment of disease activity in any form of MS.…”