Prodromes in multiple sclerosis and related disorders

Prodromal phases are well recognized in several diseases, but the possibility of a prodrome in autoimmune inflammatory demyelinating disorders of the CNS—multiple sclerosis (MS), aquaporin-4 antibody NMOSD (AQP4+NMOSD), and MOGAD—has received relatively little attention until the past few years. A prodromal phase in MS and AQP4+NMOSD, with increased health care use, was observed up to 5 years preceding the first clinical attack. In MOGAD, prodrome seems to onset in close temporal association to time of disease onset. Defining prodrome in MS, NMOSD and MOGAD will allow the diagnosis of these diseases to be made before standard clinic-radiological definition, shortening the lag phase between the biological and disease onset, starting early disease modifying therapies and delaying the onset of diseases and disability.Up to date critical challenge remains the recognition of the prodromal phase, which is largely defined by nonspecific symptoms common in the general population. Study heterogeneity, short follow-up durations, and small sample sizes currently limit the generalizability of available findings, highlighting the need for larger and more homogeneous studies. The prodromal stage of MS needs to be fully characterized through prospective studies that focus on informative populations such as people with radiologically isolated syndrome or first-degree relatives with MS. The duration of the prodrome is uncertain and we need a clearer understanding of the myriad of signs and symptoms that can occur in the years leading up to MS, NMOSD and MOGAD onset. Moreover, the pathophysiological mechanisms that underpin the diseases prodrome remain speculative.All these data could improve our understanding of the pathogenic process, identify a therapeutic window for early intervention, and ultimately transform the diagnostic and preventive paradigm of MS.In this Research Topic, we welcome submission of basic, translational, and clinical research that describes the epidemiology of prodrome in patients with MS and related disorders, and the mechanisms underlying them. We welcome the submission of Original Research, Review, Mini Review, Systematic review, and Perspective articles. Subtopics include but are not limited to the following:• The prevalence and incidence of prodrome in MS, NMOSD and MOGAD;• Research which explores the pathophysiological mechanisms that underpin the MS, NMOSD and MOGAD prodrome;• Identification and validation of clinical, genetic, imaging and fluid biomarkers of prodromal MS and related disorders;• The impact of earlier recognition and diagnosis of MS, NMOSD and MOGAD on diseases onset and outcome. Topic editors: Viviana Nociti, Giuseppe Fenu, Lorena Lorefice, Marina Romozzi Source: https://www.frontiersin.org/research-topics/77918/prodromes-in-multiple-sclerosis-and-related-disorders