Prodrome in relapsing‐remitting and primary progressive multiple sclerosis

Wijnands, José M.A.; Zhu, Feng; Kingwell, Elaine; Zhao, Yinshan; Evans, Charity; Fisk, John D.; Marrie, Ruth Ann; Tremlett, Helen

doi:10.1111/ene.13925

Cited by 27 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Solid preclinical and clinical data support the role of viral infections in MS etiology. It is plausible that MS neurodegenerative and inflammatory processes start years before the epiphany of radiological and clinical manifestations (4)(5)(6)(7). In this context, viral agents are good candidates to uncover the disease, as they are capable to precipitate the dysimmune process via multiple mechanisms: molecular mimicry, bystander activation, epitope spreading, autoreactive immune cell survival and immortalization, regulome modifications (3,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started?

et al. 2021

View full text Add to dashboard Cite

Current knowledge on Multiple Sclerosis (MS) etiopathogenesis encompasses complex interactions between the host’s genetic background and several environmental factors that result in dysimmunity against the central nervous system. An old-aged association exists between MS and viral infections, capable of triggering and sustaining neuroinflammation through direct and indirect mechanisms. The novel Coronavirus, SARS-CoV-2, has a remarkable, and still not fully understood, impact on the immune system: the occurrence and severity of both acute COVID-19 and post-infectious chronic illness (long COVID-19) largely depends on the host’s response to the infection, that echoes several aspects of MS pathobiology. Furthermore, other MS-associated viruses, such as the Epstein-Barr Virus (EBV) and Human Endogenous Retroviruses (HERVs), may enhance a mechanistic interplay with the novel Coronavirus, with the potential to interfere in MS natural history. Studies on COVID-19 in people with MS have helped clinicians in adjusting therapeutic strategies during the pandemic; similar efforts are being made for SARS-CoV-2 vaccination campaigns. In this Review, we look over 18 months of SARS-CoV-2 pandemic from the perspective of MS: we dissect neuroinflammatory and demyelinating mechanisms associated with COVID-19, summarize pathophysiological crossroads between MS and SARS-CoV-2 infection, and discuss present evidence on COVID-19 and its vaccination in people with MS.

show abstract

Section: Introductionmentioning

confidence: 99%

Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The last 5 years have seen the emergence of populationbased studies which objectively measured signs and symptoms occurring before classical MS onset (8,(11)(12)(13)(14)(15)(16)(17)(18). Importantly, the designs of these studies minimize the potential for both selection and recall bias.…”

Section: The Ms Prodrome: Key Findingsmentioning

confidence: 99%

The Multiple Sclerosis Prodrome: Evidence to Action

2022

View full text Add to dashboard Cite

A growing body of work points toward the existence of a clinically symptomatic prodromal phase in multiple sclerosis (MS) that might span 5–10 years or more. A prodrome is an early set of signs or symptoms predating the onset of classical disease, which in turn predates a definitive diagnosis. Evidence for a prodromal phase in MS could have major implications for prevention, earlier recognition and treatment, as well as an improved disease course or prognosis. This Perspective provides a succinct overview of the recent advances in our understanding of the MS prodrome and current key challenges. Many of the MS prodromal features characterized thus far are non-specific and are common in the general population; no single feature alone is sufficient to identify an individual with prodromal MS. Biomarkers may increase specificity and accuracy for detecting individuals in the MS prodromal phase, but are yet to be discovered or formally validated. Progress made in the elucidation of prodromal phases in other neurological and immune-mediated diseases suggests that these barriers can be overcome. Therefore, while knowledge of a prodromal phase in MS remains nascent, how best to move from the rapidly growing evidence to research-related action is critical. Immediate implications include refining the concept of the MS continuum to include a prodromal phase. This will help inform the true “at risk” period when considering exposures that might cause MS. Major long-term implications include the earlier recognition of MS, improved prognosis, through earlier disease management, and the future possibility of MS disease prevention.

show abstract

“…Studies based on healthcare utilization also suggest that misdiagnoses and missed opportunities for earlier recognition of MS are apparent, as well as non-neurological and atypical symptoms pre-dating classical MS onset. [8][9][10] Thus, an improved understanding of all these features offers another path towards understanding the early events leading up to the onset and recognition of MS, and will help to optimize diagnostic approaches and treatment strategies.…”

Section: The Multiple Sclerosis Prodrome Is Just Unspecific Symptoms In Radiologically Isolated Syndrome Patients -Nomentioning

confidence: 99%

“… 7 Reasons for these increases included mental health issues, skin-related disorders, sleep alterations, sensory disturbances and bladder dysfunction. 8 , 9 In these studies, while MRI-related findings for participants were not available, it would be reasonable to hypothesize that many could also have demyelinating lesions in the CNS. Studies based on healthcare utilization also suggest that misdiagnoses and missed opportunities for earlier recognition of MS are apparent, as well as non-neurological and atypical symptoms pre-dating classical MS onset.…”

mentioning

confidence: 99%