From the prodromal stage of multiple sclerosis to disease prevention

Ruth Ann Marrie, Mark Allegretta, Lisa F. Barcellos, Bruce Bebo, Peter A. Calabresi, Jorge Correale, Benjamin Davis, Philip L. De Jager, Christiane Gasperi, Carla Greenbaum, Anne Helme, Bernhard Hemmer, Pamela Kanellis, Walter Kostich, Douglas Landsman, Christine Lebrun-Frenay, Naila Makhani, Kassandra L. Munger, Darin T. Okuda, Daniel OntanedaRonald B. Postuma, Jacqueline A. Quandt, Sharon Roman, Shiv Saidha, Maria Pia Sormani, Jon Strum, Pamela Valentine, Clare Walton, Kathleen M. Zackowski, Yinshan Zhao, Helen Tremlett

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


A prodrome is an early set of signs or symptoms that indicate the onset of a disease before more typical symptoms develop. Prodromal stages are well recognized in some neurological and immune-mediated diseases such as Parkinson disease, schizophrenia, type 1 diabetes mellitus and rheumatoid arthritis. Emerging evidence indicates that a prodromal stage exists in multiple sclerosis (MS), raising the possibility of intervention at this stage to delay or prevent the development of classical MS. However, much remains unclear about the prodromal stage of MS and considerable research is needed to fully characterize the prodrome and develop standardized criteria to reliably identify individuals with prodromal MS who are at high risk of progressing to a diagnosis of MS. In this Roadmap, we draw on work in other diseases to propose a disease framework for MS that incorporates the prodromal stage, and set out key steps and considerations needed in future research to fully characterize the MS prodrome, identify early disease markers and develop standardized criteria that will enable reliable identification of individuals with prodromal MS, thereby facilitating trials of interventions to slow or stop progression beyond the prodrome.

Original languageEnglish
Pages (from-to)559-572
Number of pages14
JournalNature Reviews Neurology
Issue number9
StatePublished - Sep 2022
Externally publishedYes


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