In fact, if the damage done by MS is not big enough it is not even called MS. People with demyelinating lesions similar to MS are called RIS and are considered "non-MS" patients, even if they share the same MS-underlying condition.
Therefore research into biomarkers that could show that underlying condition are important for early diagnosis. But even if a lot of them are known, they have a protocol for approval similar to those for drugs. Following https://www.nature.com/articles/nrneurol.2015.173 is like:
There is a freely available review at [https://www.researchgate.net/publicatio ... t_findings] about the status of knowledge as of 2017, and a wide classification in groups in [https://academic.oup.com/brain/article/ ... 463/266245]
I am gonna try to maintain here a review about some diagnostic tests that are still not in clinical use. Most of them also will serve in the future to monitor the evolution and response to medications:
Advanced MRI technologies
*DTI: MRI that shows Normal Appearing White Matter
*SWI: Susceptibility weighted Imaging: Shows veins, including the central vein of MS lesions.
*MRN: magnetic resonance neurography: Shows damage in peripheral nervous system.
Other imaging technologies
*PET: Positron emission tomography: Can show activated microglia. They are based in a kind of contrast called radioligand. The most recently found is [18F]GE-180 (https://ejnmmires.springeropen.com/arti ... 017-0340-x)
*OCT: Optical coherence tomography: Inspection of the eye's retina.
Body Fluid biomarkers
*CSF oligoclonal bands: Currently used in clinical diagnosis
*CSF specific proteins
*MRZ Reaction: Measles Rubeola and Zoster reaction (two positives out of three)
*Light chains (pieces of immunoglobulins) in blood or CSF
*Neurofilament light: [2]
*microRNAs (miRNAs) in blood or CSF: [1][2]. They are associated with "circulated exosomes" (Exosomes are nano-sized particles shed by almost all cell types in the body and are packed with micro-RNAs and other types of small RNA)
*Cytokines and interleukins (ILs): Serum level of interleukin 36 in patients with multiple sclerosis (https://www.tandfonline.com/doi/abs/10. ... ode=ljii20)
*RNA analysis: Test to test several properties of RNA in blood based in this paper: https://www.ncbi.nlm.nih.gov/pubmed/23748426. Explained here [http://patientactivationnetwork.com/wp- ... iew_MS.pdf]. It is commercially available here: https://www.iquitylabs.com/lab-login/
*Neurofilaments ELISA/NFL tests. Are also commercially available. For example https://www.ibl-international.com/en/ne ... ight-elisa
In the news:
*micro-RNAs: Nine unique micro-RNA molecules that differentiate between two MS sub-types: relapsing-remitting MS (RRMS) and progressive MS [https://www.sciencedaily.com/releases/2 ... 095425.htm]
*Osteopontin in blood [https://www.ncbi.nlm.nih.gov/pubmed/29346446]