What Is the MS Prodrome?

What Is the MS Prodrome?

What Is the MS Prodrome?
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Published on November 19, 2025
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Multiple sclerosis (MS) is a chronic autoimmune neurological disease that can cause symptoms throughout the body, including vision problems, muscle weakness, balance problems, cognitive dysfunction, and more.

 The unpredictability of MS — in terms of progression and severity — makes it difficult to foretell the course of one’s disease. What is clear is that intervening as early as possible with disease-modifying treatment is critical for reducing relapses and delaying disease progression.
Scientists are uncovering that there may be a critical window of opportunity where certain signs and symptoms begin to emerge more than a dozen years before the onset of typical symptoms of MS. This is called the MS prodrome.

“The MS prodrome is an evolving concept that we’ve begun to appreciate in recent years,” says Ahmed Abdelhak, MD, assistant professor of neurology at the University of California in San Francisco. “Research is coming together showing that patients with MS, like many other patients with chronic diseases, have a stage or time period before the disease becomes symptomatic or they start noticing their first symptoms. We believe that during this time, certain changes are happening in the body due to the chronic inflammatory process occurring,” he says.

Common Signs and Symptoms of the MS Prodrome

In the years before MS symptom onset, people who go on to develop MS use the healthcare system more often. This was first explored in a published study in The Lancet Neurology in 2017.

“We found that people were more likely to be hospitalized for any reason in the five years before MS onset. That raised many questions, such as ‘How far back can we pick up elevated healthcare use?’” says study coauthor Helen Tremlett, PhD, a professor at The University of British Columbia in the UBC Division of Neurology in Vancouver.

The researchers’ most recent data, published in 2025, looked at the 25 years preceding clinical MS symptom onset.

 They found that the prodrome may appear even earlier than previously suspected, with people visiting their doctor more often starting 14 to 15 years before the first MS symptoms, compared with those who did not have MS.
Overall, the research suggests that these symptoms and health conditions may appear in the MS prodrome:

  • Anxiety
  • Depression
  • Migraine
  • Dizziness
  • Vertigo
  • Insomnia
  • Visual disturbances
  • Osteoarthritis
  • Knee joint disorders
In addition, the following symptoms and conditions may arise in the MS prodrome:

  • Fatigue
  • Anemia
  • Bowel and bladder disturbances
  • Fibromyalgia
  • Pain

Can the MS Prodrome Be Diagnosed?

At this time, there’s no way to diagnose the MS prodrome. Right now, research is focused on examining patterns of healthcare use in large groups of people. The majority of people who visit doctors for the issues above do not and will not develop MS, says Dr. Tremlett. “Our findings are not sufficient to predict who will develop MS,” she says.

Keep in mind that many of the symptoms above, such as fatigue, are classified as “nonspecific symptoms,” meaning symptoms that are common in many conditions, which can range from benign to serious.

 This means that having fatigue, mood changes, or insomnia doesn’t mean you have MS, as these can be caused by various medical and lifestyle factors.

However, that may change in the future, as research advances. “There may be potential to recognize and perhaps diagnose and manage MS earlier than we can currently. We’re not there yet, but our research opens that door to future opportunity,” says Tremlett.

So what could this look like? One research review points out that future prodrome diagnosis could be based on an algorithm, analyzing a combination of prodromal symptoms, MS risk factors (such as being female and under 50), and imaging tests to look for lesions on the brain and spine.

 Right now, this is hypothetical, but it provides an idea of how this information could be used.

MS Prodrome Progression to Multiple Sclerosis

As noted above, doctor visits tend to increase up to 15 years before the onset of MS symptoms. Some of the earliest doctor visits were mental health related, while others were for ill-defined signs and symptoms.

 As the date of MS symptom onset drew closer, the types of healthcare providers people saw changed. “We saw a growing range of visits to other specialists, such as ophthalmologists and neurologists,” Tremlett says.

Still, there are many unanswered questions. “We don’t know if everyone who has MS has a prodrome. I think it’s highly possible that some people do not,” says Tremlett, who suspects that there’s likely a large variation, with some having a marked prodromal phase and others not having any. This itself is a guess, she says.

Also worth noting is that the diagnosis criteria for MS were updated in 2024.

 The criteria allow for earlier diagnosis, says Tremlett.

One change to the criteria, for example, is that lesions on the optic nerve can be used to identify MS, as one-quarter of those with MS have optic neuritis (inflammation of the optic nerve) as their initial sign of the disease.

Biomarkers and the MS Prodrome

In addition to healthcare usage, researchers are also analyzing biomarkers that arise during the MS prodrome.

For example, Dr. Abdelhak was part of recent research that found that people who go on to develop MS have higher levels of certain proteins in their blood indicating early damage to myelin and nerve fibers than people who do not develop MS, even before MS symptom onset.

These antibody levels had changed seven years before those with MS had their first symptoms. “Before onset, there was already evidence of myelin injury in the blood. We then saw nerve injury, and then other areas of the brain affected. For the first time, we were able to define the sequence of events happening. We learned that there are actually broad changes in the immune system at that time — and we can even measure those changes,” Abdelhak says.

Eventually, this and other identified biomarkers can give researchers a picture of who might develop MS.

“Finding people going through the MS prodrome who are at high risk of transitioning to MS or developing symptomatic MS and starting treatment is something that we believe can improve the disease course substantially. It’s a time when the disease is asymptomatic, which means you might have the opportunity to prevent MS from evolving completely,” says Abdelhak.

Future Research on the MS Prodrome

All in all, the research on the MS prodrome is still in its early stages. According to one review, we still need to understand:

  • Length of the prodrome
  • How to correctly identify those who will (and won’t) progress to MS
  • Potential benefits of early treatment

As we look forward to how the MS prodrome may be used in treatment, experts believe that intervening at the first signs may also help lessen progression, says Abdelhak. “What we’ve come to appreciate in the last years is the earlier you start effective treatment, the better the long-term course of the disease is.”

The Takeaway

  • Researchers are investigating the MS prodrome, a phase occurring more than a dozen years before the onset of typical MS symptoms, unveiling possible early warning signs.
  • The MS prodrome is characterized by increased healthcare utilization for nonspecific symptoms such as fatigue, anxiety, or depression, which in and of themselves do not predict or diagnose MS.
  • There is currently no definitive method for diagnosing the MS prodrome, but ongoing research may eventually offer strategies for identifying it.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Multiple Sclerosis. National Institute of Neurological Disorders and Stroke. January 31, 2025.
  2. Makhani N et al. The multiple sclerosis prodrome. Nature Reviews Neurology. August 1, 2021.
  3. Wijnands JMA et al. Health-care use before a first demyelinating event suggestive of a multiple sclerosis prodrome: a matched cohort study. The Lancet Neurology. June 2017.
  4. Ruiz-Algueró M et al. Health Care Use Before Multiple Sclerosis Symptom Onset. JAMA Network Open. August 1, 2025.
  5. Haddad RN et al. The Multiple Sclerosis Prodrome: Past, Present, and Future. Practical Neurology. March 2023.
  6. Smith CF et al. Patient characteristics, serious disease diagnoses, and incidental findings in individuals with non-specific symptoms referred to the Suspected CANcer (SCAN) Pathway: a prospective cohort study in England. The Lancet Primary Care. September 2025.
  7. Harding KE et al. Prodromal multiple sclerosis: considerations and future utility. Journal of Neurology. February 11, 2024.
  8. Montalban X et al. Diagnosis of multiple sclerosis: 2024 revisions of the McDonald Criteria. The Lancet Neurology. October 2025.
  9. Abdelhak A et al. Myelin injury precedes axonal injury and symptomatic onset in multiple sclerosis. Nature Medicine. October 20, 2025.
Meet Our Experts
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Barbara S. Giesser

Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM

Medical Reviewer

Barbara S. Giesser, MD, FAAN, FANA, Dipl. ABLM, is a neurologist who has specialized in the care of persons with multiple sclerosis since 1982. She has been faculty in the departments of neurology at the Albert Einstein College of Medicine, the University of Arizona Health Science Center, and the David Geffen UCLA School of Medicine, where she is professor emeritus of clinical neurology.

She currently directs the MS Comprehensive Care Clinic at the Pacific Neuroscience Institute in Santa Monica, California. Her clinical strategy combines state of the art diagnostics and therapeutics with integration of lifestyle practices to develop a comprehensive, personalized treatment plan for each patient.

Dr. Giesser’s professional activities throughout her career have been primarily as a clinician, educator, and advocate. She has created curricula in MS for trainees at all levels, as well as peers and lay audiences. She has also created wellness curricula for the American Academy of Neurology (AAN) and the National MS Society.

She serves and has served on task forces convened by the National MS Society to generate expert consensus recommendations on wellness research and practical recommendations for clinicians, specifically in the areas of diet and exercise. She has been recognized for educational and clinical achievement at local, regional, and national levels, including the 2018 American Academy of Neurology Frank Rubino Award for Excellence in Clinical Neurology Training, and the 2022 AAN/American Brain Foundation Ted Burns Humanism in Neurology Award.

Giesser has been an investigator on several clinical trials of novel therapeutic agents for MS, and has also conducted peer reviewed exercise-related research. Her CV includes over 100 peer-reviewed publications, books, and chapters.

Giesser has been active in advocacy efforts for over two decades. She has lobbied at state and federal levels to promote legislation on behalf of patients, neuroscience research, and the practice of neurology.

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Jessica Migala

Author

Jessica Migala is a freelance writer with over 15 years of experience, specializing in health, nutrition, fitness, and beauty. She has written extensively about vision care, diabetes, dermatology, gastrointestinal health, cardiovascular health, cancer, pregnancy, and gynecology. She was previously an assistant editor at Prevention where she wrote monthly science-based beauty news items and feature stories.

She has contributed to more than 40 print and digital publications, including Cosmopolitan, O:The Oprah Magazine, Real Simple, Woman’s Day, Women’s Health, Fitness, Family Circle, Health, Prevention, Self, VICE, and more. Migala lives in the Chicago suburbs with her husband, two young boys, rescue beagle, and 15 fish. When not reporting, she likes running, bike rides, and a glass of wine (in moderation, of course).

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