To summarize current knowledge about the temporal evolution of multiple sclerosis (MS), including early risk factors, emerging biomarkers, and the concept of MS as a biological continuum, defined as the gradual progression from genetic and environmental influences to clinical manifestations.
Key Findings:
MS may unfold along a biological continuum that includes genetic susceptibility, environmental exposures, and early nonspecific symptoms, which may not be immediately recognized as related to MS.
The strongest genetic association with MS is observed in the HLA region, particularly HLA-DRB1*15:01, which triples the risk of developing MS.
Emerging biomarkers and advances in neuroimaging are crucial for detecting disease-related processes at earlier stages, potentially leading to earlier interventions.
Interpretation:
The review discusses the evolution of MS from genetic and environmental susceptibility through to clinically definite MS, emphasizing the need for improved risk stratification and monitoring strategies, particularly for individuals at higher risk.
Limitations:
Absence of biomarkers with sufficient specificity to reliably characterize preclinical or prodromal biological disease activity, such as those that can differentiate between MS and other neurological conditions.
Lack of validated tools to translate findings into clinical practice, which hampers the application of research insights in real-world settings.
Conclusion:
Conceptualizing MS as a continuum may facilitate improved understanding and management of the disease.
