Health Care Use Before Multiple Sclerosis Symptom Onset, 2025, Marta Ruiz-Algueró, MD, PhD et al

People don’t just get Alzheimer’s, Parkinson’s, or MS overnight. These diseases begin silently, often decades before diagnosis. ME/CFS doesn’t appear out of nowhere, either.

That there is an increased likelihood of coming down with ME/CFS or LC after an infection if you had prior mental health issues is a sign that the brain and nervous system have already been 'dysfunctional' and that there might have been 'structural' damage before, we just don't understand and have the capability to see it yet.

Medicine has a tendency to blame the mind when it doesn't understand what is going on mechanistically in the same way creationists will point towards god and how unknowable his ways are if they see no other out.

On the other hand, the kneejerk reaction by many to disregard the possibility that severe psychological (which by definition is always physical at some level) trauma could potentially influence future health outcomes is almost as ignorant as the BPS pundits' bullshit. The fact of the matter is that it's extremely difficult to untangle cause and effect in complex systems, especially for beings that think and reason linearly and by analogy.

The human body has many trillion cells, each of these cells boasts a billion or so chemical reactions every second. I think all of us, but the medical field in particular would be well advised to say 'we don't know yet' more often. Being less certain (of opinions and conceptual frameworks used) opens up mindspace for learning.
 
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Snow Leopard said:
Doesn't this strain the meaning of "MS onset"? Diagnosis is not the same as onset. Patients had MS related symptoms years before that diagnosis, maybe that should be considered the real onset? It seems like contradictory reasoning..
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That's just a matter of definition, I guess. My hunch is that we can't know for certain whether mental health issues predispose to or are MS yet. Even if we would understand the whole process of every individual's MS mechanistically (we are not even close) you would have to draw a line at some point. To diagnose means to discern which means to invent conceptual boxes with certain observable characteristics with a certain specificity. Anxiety for example is just not understood enough to get rid of it as a diagnostic box, not everybody with anxiety will get MS, and not everybody's MS with prior anxiety will be automatically tied to it. But I guess we do know enough about mental health issues for MDs to consider a more thorough workup for 'physiological causes' (with follow ups) more often.
 
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Midnattsol said:
With FND and «we won’t test for the same again to reduce cost your anxiety» becoming prevalent in healthcare this is indeed dystopian.
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Amw66 said:
You can have even have a new diagnosis but still retain the FND.
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But with white matter microstructural imaging, maybe the cat's out of the bag. It will inevitably be used more and more until it's routine, eg in Parkinson's: A worldwide study of white matter microstructural alterations in people living with Parkinson’s disease (2024, Nature npj Parkinson's Disease)

So if what is termed "MS" is the T2 hyperintensities / white matter plaques we have been able to easily see for decades, but "comorbid FND" is the abnormal white matter microstructure we can now see in what used to be Normal Appearing White Matter adjacent to the visible lesions…

… then maybe you could simply subtract "MS" entirely and find that FND is abnormal white matter microstructure that otherwise appears normal on routine neuroimaging.

There is some early evidence of this from FND researchers: Reduced microstructural white matter integrity is associated with the severity of physical symptoms in functional neurological disorder (2025) —

Patients with FND present widespread reduced microstructural integrity in the brain
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Conceivably, some or even all of FND is actually early stage MS that never progresses beyond this white matter dysfunction to produce visible destructive lesions. We might find that there's primary progressive, relapsing-remitting, (plus progressive-relapsing) and now "non-progressive, non-remitting, early-stage".
 
SNT Gatchaman said:
But with white matter microstructural imaging, maybe the cat's out of the bag. It will inevitably be used more and more until it's routine, eg in Parkinson's: A worldwide study of white matter microstructural alterations in people living with Parkinson’s disease (2024, Nature npj Parkinson's Disease)

So if what is termed "MS" is the T2 hyperintensities / white matter plaques we have been able to easily see for decades, but "comorbid FND" is the abnormal white matter microstructure we can now see in what used to be Normal Appearing White Matter adjacent to the visible lesions…

… then maybe you could simply subtract "MS" entirely and find that FND is abnormal white matter microstructure that otherwise appears normal on routine neuroimaging.

There is some early evidence of this from FND researchers: Reduced microstructural white matter integrity is associated with the severity of physical symptoms in functional neurological disorder (2025) —



Conceivably, some or even all of FND is actually early stage MS that never progresses beyond this white matter dysfunction to produce visible destructive lesions. We might find that there's primary progressive, relapsing-remitting, (plus progressive-relapsing) and now "non-progressive, non-remitting, early-stage".
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I completely agree.

Which is why I find it questionable to say that 'no structural changes' have been observed in ME/CFS patients. Something that's being pushed on here quite a bit.

Mirostructural brain changes have been observed in ME/CFS using advanced MRI techniques, findings are still preliminary and not yet standardized and replicated, but that doesn't mean they are not there or potentially pathological. I think it should be communicated in that spirit.
 
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Utsikt said:
Edit: and of course he refuses to acknowledge the widespread neglect and gaslighting, says its often missed due to a lack of early biomarkers. Keep fooling yourself.
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Well, yeah, that's exactly the problem. The biopsychosocial literature is filled with mentions of how the biomedical model is supreme, and present itself as the solution for it. Biopychosocial isn't the solution at all, but the problem is very real, the idea that they can throw millions of people in trash dumps until they get technological benediction is 1) insane and 2) completely unacceptable.

But if you point it out, they literally excuse it, hence the problem isn't with the biomedical model, it's with the profession itself. This is not a binary choice, where one excludes the other. In fact medical training is itself filled with warnings about how strictly relying on such tests is inappropriate, but they excuse every failure that results from it anyway, because it's a type of failure that has so little impunity, not only is there no pressure to improve on it, all the pressure pushes towards making it worse.
 
SNT Gatchaman said:
Things will improve when neuroimaging advances
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I fear they won't, with basic imaging being so restricted, because of cost and availability, more advanced machines would be even more restricted, and so even if they were useful in research, clinically they would be irrelevant for this problem since they wouldn't be 'wasted' on "reassuring anxious patients".

Unless someone manages to pull off incredible advances that make them not only more advanced, but more available. Which may yet happen, but mostly depends on improvements in basic science and manufacturing. And likely AI.
 
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