Enhancing Emergency Medicine's Role in Early MS Diagnosis

Enhancing the role of emergency medicine in the early diagnosis of multiple sclerosis (MS) through the recognition of subtle signs and integrative diagnostic techniques can lead to better patient management and outcomes.

Emerging evidence shows that subtle warning signs of MS can appear 15 years before diagnosis, often manifesting as transient paresthesias, mild motor weakness or cognitive fog. In a busy emergency department, recognizing MS symptoms early is vital; otherwise, these subtle neurological symptoms may be mistaken for benign findings, delaying referrals to neurology and missing opportunities for early intervention in MS.

Real-world data indicate that patients referred only after overt relapses already exhibit significant deficits. A comprehensive review found that delayed diagnosis correlates with accelerated MS progression and increased disability. Early multiple sclerosis diagnosis therefore allows timely initiation of disease-modifying therapies, potentially altering the disease trajectory.

Preclinical multiple sclerosis presentations include radiologically isolated syndrome—characterized by incidental MRI lesions without clinical symptoms—and a prodrome of fatigue, mood disturbances and bladder dysfunction that precede motor findings.

A recent analysis of teriflunomide’s effect on time to clinical multiple sclerosis highlights a delay in conversion to clinically definite MS among treated patients, underscoring the potential impact of early therapeutic intervention.

Integrating early detection of multiple sclerosis into emergency protocols demands heightened vigilance for the MS prodrome and standardized pathways for advanced imaging and lumbar puncture. Embedding decision-support tools that flag suspicious combinations of subtle neurological symptoms and leveraging point-of-care biomarkers under investigation could streamline the transition from emergency evaluation to specialized care. Sharing data with neurology teams and educating frontline staff on emerging preclinical MS symptoms will be vital in closing referral gaps.

Key Takeaways:

• Understanding subtle early signs of MS is essential for timely intervention and improved outcomes.
• Early diagnosis can significantly delay disability progression and reduce disease activity.
• Although preclinical indicators of MS are under active investigation, they are not yet incorporated into established diagnostic criteria.