A journey with no roadmap—The need for validated criteria of the MS prodrome

BACKGROUND: A growing body of compelling evidence has emerged to validate a set of signs and symptoms that indicates the onset of disease before more typical signs and symptoms present to fulfill a diagnosis of MS. On 24 June 2021, a group of international researchers, patient advocates, and Society representatives led by Professors Helen Tremlett (University of British Columbia) and Ruth Ann Marrie (University of Manitoba) convened virtually for a workshop. OBJECTIVE: Identify key gaps in knowledge, opportunities, and research priorities regarding the prodromal stage of MS. METHODS: The group developed a new framework for MS that includes the stage of early signs and symptoms of MS—and outlined a roadmap to guide future research, with the “goal of preventing the progression to onset of typical symptoms of MS in those who present during the prodromal stage of MS”. RESULTS: If high-risk individuals in the early stages of MS can be identified with a high degree of certainty, there is an opportunity to intervene and minimize the risk of progressing to typical MS symptoms and a diagnosis of MS. CONCLUSION: Standardized criteria must be developed, validated, and point of intervention found to better recognize, better diagnose, and better treat MS.