Using VISIBL-MS to Improve Early Detection and Diagnostic Pathways in Multiple Sclerosis

Timely diagnosis of multiple sclerosis (MS) remains a persistent challenge despite advances in diagnostic criteria and imaging biomarkers. While the 2017 and updated 2024 McDonald criteria have improved the ability to identify MS earlier along its biological continuum, delays in recognition and referral continue to impact patient outcomes. Emerging data suggest that patients diagnosed within shorter timeframes, often within 6 months of symptom onset, experience more favorable long-term outcomes, underscoring the importance of early identification and intervention.

A key barrier lies not in the criteria themselves, but in the real-world implementation of MS recognition pathways. Patients must first enter the diagnostic journey through accurate symptom recognition, often by frontline providers such as emergency department clinicians, general practitioners, and urgent care teams. However, gaps in awareness of core MS clinical syndromes, particularly outside of specialty care, contribute to prolonged diagnostic odysseys, especially among patients affected by social determinants of health.

At the 2026 American Academy of Neurology (AAN) Annual Meeting, Jaime Imitola, MD, FAAN, FANA, Professor of Neurology, Vice-Chair of Research, and Director of the UConn Health Comprehensive MS Center, presented new validation data on VISIBL-MS, an awareness-focused tool designed to improve early symptom recognition and streamline entry into the MS diagnostic pathway. In this conversation, he discusses the rationale behind VISIBL-MS, findings from recent validation efforts, and the broader implications for reducing delays in MS diagnosis and treatment initiation.

NeurologyLive: What is VISIBL-MS and what clinical value does this tool hold?

Jaime Imitola, MD, FAAN, FANA: This was a team effort of the University of Connecticut MS Center. The first question was whether we are diagnosing people with MS on time. So, we now have a great development, which is the 2024 McDonald criteria, thanks to the work of the MS Society and others around the world. But the question that we ask in the real world, meaning when you see patients, is whether we are bringing those patients effectively into the diagnostic journey.

Every time I talk about this, I’m reminded that three things have to happen to get someone in the doors of an MS specialist. You have to recognize the clinical syndrome. You have to be able to diagnose this patient through a pathway, right, and that would be the 2024 criteria. And, you must be able to establish a therapeutic care program for that patient that is adequate for that particular patient, given the burden of disease, the type of patient, and the risk factors for progression. These three things almost must happen simultaneously.

There is a great debate about whether this is happening at the same time. If you look at countries that are developed, and even other MS centers like in Europe, in Berlin or Barcelona and others, they have data that suggest that you can diagnose people with MS within certain parameters. If you diagnose people within a certain amount of time, say less than six months, these people do better than if you diagnose the patients after six months. Now, the question is that in the United States, there is no such data, right? And, the United States is more heterogeneous in terms of the delivery of care provided for patients, depending on insurance, depending on whether you’re in a rural or urban setting, etc.

We know that even though we have about a million MS patients, probably 30% to 33% of those patients are not benefiting from the advances that we have. And the data are supported by a very fundamental paper by Solomon et al in Neurology last year that showed that if you do a survey across the world, about 60% or more of people highlight awareness of the public and awareness of providers of the signs and symptoms of MS as a major issue.

Over the years, there has been this interesting development where people think about MS as having very diffuse symptoms that are not localizable. But for the last 20 years, we have something called clinically isolated syndromes that, especially for neurologists, are well-defined phenomenology. About three years ago, the UConn team developed VISIBL-MS. VISIBL-MS is an effort to improve awareness, not for MS specialists, because we know about MS, but for ED personnel, general practitioners, urgent care—these are the people that I call first responders. They are not always aware of these important signs and symptoms, so they are missing these patients.

Let me give you an example. Right now, in the United States, if you have arm weakness and you cannot speak well, you end up immediately in the ED because of the BE-FAST mnemonic. If you have chest pain that goes to your jaw or left arm, they call an ambulance because you may have an acute coronary syndrome. That’s because awareness has become part of the common domain.

We think that MS, based on the data, is one of the areas where awareness is lacking and needs to improve. This is implementation science. I’m not an expert in it, but I collaborate with experts, including colleagues at the Institute of Public Health. We presented VISIBL-MS two years ago and published it, and since then people can download it. We have used it for educating patients, families, and general neurologists.

Now we are doing further validation. One is retrospective validation, which we are presenting now. In addition, we are validating it in rural America in collaboration with multiple states. The data we are presenting support the use of VISIBL-MS as an important tool—100% of patients newly diagnosed with MS had a symptom captured by the VISIBL-MS tool.

We also developed a card, which is free, bilingual, and includes symptoms on the front and an awareness score on the back, including modifiable risk factors. We are distributing this to anyone who wants it.

What are some of the diagnostic pitfalls that still exist, even with updated criteria?

I’ve been working in MS diagnosis for many years, and we have made progress. The 2017 criteria were effective and still are. The 2024 version aims to see MS as a biological continuum and diagnose earlier.

The question is not the criteria—it’s implementation. For almost 15 years, we’ve known that general neurologists and other providers struggle to apply the McDonald criteria. That may be due to training or confidence. Organizations are investing in education, but at the end of the day, the patient must enter the diagnostic journey.

Many neurologists are not aware of how patients actually arrive in that journey. When you study this, you realize that many patients are not even in the pathway—they are in a diagnostic odyssey that can last months or years. For patients with social determinants of health challenges, this is even more pronounced.

Time is brain. If you don’t diagnose MS on time, you cannot assume the damage is innocuous. Even if patients feel okay, lesions accumulate and increase the risk of progression.

So, the 2024 criteria are welcome, but the key question is how impactful they will be for ED physicians, general neurologists, and primary care providers. VISIBL-MS is meant to be an implementation tool to improve awareness and bring patients into the diagnostic journey earlier.

What did the validation study show?

We performed a retrospective analysis of about 131 patients over the last five years. We focused on the narrative of symptoms, capturing what patients actually described at the time. We then compared those narratives to VISIBL-MS categories. The key finding was that 100% of patients diagnosed with MS had a VISIBL-MS symptom.

We also looked at social determinants of health using the Social Deprivation Index. We found that some symptoms, like brainstem syndromes, were more associated with African American patients, which aligns with known data.

Another important finding was that optic neuritis was associated with a 3.6-times faster diagnosis compared with other syndromes. That tells us we are not recognizing transverse myelitis and brainstem syndromes as effectively.

We also found that although optic neuritis led to faster diagnosis, it did not lead to faster treatment initiation. That highlights another gap. Overall, the study validated the tool and also revealed opportunities to improve education, particularly around less recognized syndromes.

What lessons have you learned, and what’s next?

One lesson is that what seems obvious to MS specialists is not obvious to general providers. VISIBL-MS helps bridge that gap. We are now developing additional educational tools, including a film to teach the use of the card. We are focusing on patients, families, and newly diagnosed individuals, particularly around relapse recognition.

We are also planning prospective validation studies. The idea is to assess whether education changes behavior and decision-making. This is not a diagnostic tool—it’s an awareness tool. We want to achieve what stroke care has achieved, where symptoms lead to rapid evaluation and treatment. That is not happening in MS.

Many patients come to us after multiple relapses. The worst MS is undiagnosed, untreated MS. So, our goal is to shorten the diagnostic journey and bring patients into care earlier.

Transcript edited for clarity. Click here for AAN 2026 coverage.